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Background <p>Photon-counting CT (PCCT) may improve dose efficiency compared with energy-integrating detector CT (EID-CT), but evidence remains limited in very young children undergoing non-contrast preoperative chest CT under real-world clinical protocols.</p> Objective <p>To provide a size-aware matched comparison of radiation dose and image quality between PCCT and EID-CT in infants and toddlers (≤ 36 months) undergoing non-contrast preoperative chest CT, and to examine whether the main findings remained directionally consistent across prespecified strata of age, BMI, and water-equivalent diameter (DW).</p> Methods <p>In this single-center matched cohort study, a prospective PCCT cohort and a retrospective EID-CT cohort were propensity score–matched 1:1 (49 pairs). Dose metrics (CTDI<sub>vol</sub>, DLP, SSDE) and objective and subjective image quality were evaluated, with subgroup analyses stratified by age (&lt; 12 vs. ≥ 12 months), BMI tertiles, and DW tertiles.</p> Results <p>The PCCT group showed significantly lower radiation dose metrics (CTDI<sub>vol</sub>, DLP, and SSDE) compared to the EID-CT group (<i>P</i> &lt; 0.001). In terms of objective image quality, PCCT significantly reduced image noise in all lung lobes and consistently demonstrated higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) (all <i>P</i> &lt; 0.001). Subjective image quality assessments showed no significant difference between PCCT and EID-CT (<i>P</i> &gt; 0.05). Across prespecified age, BMI, and DW strata, PCCT remained associated with lower dose metrics and favorable objective image-quality trends, although these subgroup findings should be interpreted as exploratory.</p> Conclusion <p>In this matched cohort of infants and toddlers undergoing non-contrast preoperative chest CT, PCCT was associated with substantially lower radiation dose and improved objective image quality compared with EID-CT, and no statistically significant difference was detected in subjective image quality scores between PCCT and EID-CT.</p>

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Infant and toddler’s preoperative chest imaging on photon-counting detector CT: a paired-sample comparison with energy-integrating detector CT on image quality and radiation dose

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月16日

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  • Xiang-Yu Liu,
  • Wei Zhou,
  • Ruo-Yang Shi,
  • Wei-Hui Xie,
  • Wei-Dong Qiao,
  • Tang-Xu Sun,
  • Sheng-Yang Xu,
  • Ji Wang,
  • Lian-Ming Wu

摘要

Background

Photon-counting CT (PCCT) may improve dose efficiency compared with energy-integrating detector CT (EID-CT), but evidence remains limited in very young children undergoing non-contrast preoperative chest CT under real-world clinical protocols.

Objective

To provide a size-aware matched comparison of radiation dose and image quality between PCCT and EID-CT in infants and toddlers (≤ 36 months) undergoing non-contrast preoperative chest CT, and to examine whether the main findings remained directionally consistent across prespecified strata of age, BMI, and water-equivalent diameter (DW).

Methods

In this single-center matched cohort study, a prospective PCCT cohort and a retrospective EID-CT cohort were propensity score–matched 1:1 (49 pairs). Dose metrics (CTDIvol, DLP, SSDE) and objective and subjective image quality were evaluated, with subgroup analyses stratified by age (< 12 vs. ≥ 12 months), BMI tertiles, and DW tertiles.

Results

The PCCT group showed significantly lower radiation dose metrics (CTDIvol, DLP, and SSDE) compared to the EID-CT group (P < 0.001). In terms of objective image quality, PCCT significantly reduced image noise in all lung lobes and consistently demonstrated higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) (all P < 0.001). Subjective image quality assessments showed no significant difference between PCCT and EID-CT (P > 0.05). Across prespecified age, BMI, and DW strata, PCCT remained associated with lower dose metrics and favorable objective image-quality trends, although these subgroup findings should be interpreted as exploratory.

Conclusion

In this matched cohort of infants and toddlers undergoing non-contrast preoperative chest CT, PCCT was associated with substantially lower radiation dose and improved objective image quality compared with EID-CT, and no statistically significant difference was detected in subjective image quality scores between PCCT and EID-CT.