Feasibility of multi-contrast imaging on dual-source photon counting detector (PCD) CT: An initial phantom study

Spectral optimization using fast kV switching and filtration for photon counting CT with realistic detector responses: a simulation study

Purpose

Photon counting CT (PCCT) provides spectral measurements for material decomposition. However, the image noise (at a fixed dose) depends on the source spectrum. Our study investigates the potential benefits from spectral optimization using fast kV switching and filtration to reduce noise in material decomposition.

Approach

The effect of the input spectra on noise performance in both two-basis material decomposition and three-basis material decomposition was compared using Cramer-Rao lower bound analysis in the projection domain and in a digital phantom study in the image domain. The fluences of different spectra were normalized using the CT dose index to maintain constant dose levels. Four detector response models based on Si or CdTe were included in the analysis.

Results

For single kV scans, kV selection can be optimized based on the imaging task and object size. Furthermore, our results suggest that noise in material decomposition can be substantially reduced with fast kV switching. For two-material decomposition, fast kV switching reduces the standard deviation (SD) by ∼ 10 % . For three-material decomposition, greater noise reduction in material images was found with fast kV switching (26.2% for calcium and 25.8% for iodine, in terms of SD), which suggests that challenging tasks benefit more from the richer spectral information provided by fast kV switching.

Conclusions

The performance of PCCT in material decomposition can be improved by optimizing source spectrum settings. Task-specific tube voltages can be selected for single kV scans. Also, our results demonstrate that utilizing fast kV switching can substantially reduce the noise in material decomposition for both two- and three-material decompositions, and a fixed Gd filter can further enhance such improvements for two-material decomposition.

One-step inverse generation network for sparse-view dual-energy CT reconstruction and material imaging

Objective.Sparse-view dual-energy spectral computed tomography (DECT) imaging is a challenging inverse problem. Due to the incompleteness of the collected data, the presence of streak artifacts can result in the degradation of reconstructed spectral images. The subsequent material decomposition task in DECT can further lead to the amplification of artifacts and noise.Approach.To address this problem, we propose a novel one-step inverse generation network (OIGN) for sparse-view dual-energy CT imaging, which can achieve simultaneous imaging of spectral images and materials. The entire OIGN consists of five sub-networks that form four modules, including the pre-reconstruction module, the pre-decomposition module, and the following residual filtering module and residual decomposition module. The residual feedback mechanism is introduced to synchronize the optimization of spectral CT images and materials.Main results.Numerical simulation experiments show that the OIGN has better performance on both reconstruction and material decomposition than other state-of-the-art spectral CT imaging algorithms. OIGN also demonstrates high imaging efficiency by completing two high-quality imaging tasks in just 50 seconds. Additionally, anti-noise testing is conducted to evaluate the robustness of OIGN.Significance.These findings have great potential in high-quality multi-task spectral CT imaging in clinical diagnosis.

Visual and Quantitative Evaluation of Low-Concentration Bismuth in Dual-Contrast Imaging of Iodine and Bismuth Using Clinical Photon-Counting CT

Simultaneous dual-contrast imaging of iodine and bismuth has shown promise in prior phantom and animal studies utilizing spectral CT. However, it is noted that in previous studies, Pepto-Bismol has frequently been employed as the source of bismuth, exceeding the recommended levels for human subjects. This investigation sought to assess the feasibility of visually differentiating and precisely quantifying low-concentration bismuth using clinical dual-source photon-counting CT (PCCT) in a scenario involving both iodinated and bismuth-based contrast materials. Four bismuth samples (0.6, 1.3, 2.5, and 5.1 mg/mL) were prepared using Pepto-Bismol, alongside three iodine rods (1, 2, and 5 mg/mL), inserted into multi-energy CT phantoms with three different sizes, and scanned on a PCCT system at three tube potentials (120, 140, and Sn140 kV). A generic image-based three-material decomposition method generated iodine and bismuth maps, with mean mass concentrations and noise levels measured. The root-mean-square errors for iodine and bismuth determined the optimal tube potential. The tube potential of 140 kV demonstrated optimal quantification performance when both iodine and bismuth were considered. Distinct differentiation of iodine rods with all three concentrations and bismuth samples with mass concentrations ≥ 1.3 mg/mL was observed across all phantom sizes at the optimal kV setting.

Photon-Counting Computed Tomography in Atherosclerotic Plaque Characterization

Atherosclerotic plaque buildup in the coronary and carotid arteries is pivotal in the onset of acute myocardial infarctions or cerebrovascular events, leading to heightened levels of illness and death. Atherosclerosis is a complex and multistep disease, beginning with the deposition of low-density lipoproteins in the arterial intima and culminating in plaque rupture. Modern technology favors non-invasive imaging techniques to assess atherosclerotic plaque and offer insights beyond mere artery stenosis. Among these, computed tomography stands out for its widespread clinical adoption and is prized for its speed and accessibility. Nonetheless, some limitations persist. The introduction of photon-counting computed tomography (PCCT), with its multi-energy capabilities, enhanced spatial resolution, and superior soft tissue contrast with minimal electronic noise, brings significant advantages to carotid and coronary artery imaging, enabling a more comprehensive examination of atherosclerotic plaque composition. This narrative review aims to provide a comprehensive overview of the main concepts related to PCCT. Additionally, we aim to explore the existing literature on the clinical application of PCCT in assessing atherosclerotic plaque. Finally, we will examine the advantages and limitations of this recently introduced technology.

Innovative advances in pediatric radiology: computed tomography reconstruction techniques, photon-counting detector computed tomography, and beyond

In pediatric radiology, balancing diagnostic accuracy with reduced radiation exposure is paramount due to the heightened vulnerability of younger patients to radiation. Technological advancements in computed tomography (CT) reconstruction techniques, especially model-based iterative reconstruction and deep learning image reconstruction, have enabled significant reductions in radiation doses without compromising image quality. Deep learning image reconstruction, powered by deep learning algorithms, has demonstrated superiority over traditional techniques like filtered back projection, providing enhanced image quality, especially in pediatric head and cardiac CT scans. Photon-counting detector CT has emerged as another groundbreaking technology, allowing for high-resolution images while substantially reducing radiation doses, proving highly beneficial for pediatric patients requiring frequent imaging. Furthermore, cloud-based dose tracking software focuses on monitoring radiation exposure, ensuring adherence to safety standards. However, the deployment of these technologies presents challenges, including the need for large datasets, computational demands, and potential data privacy issues. This article provides a comprehensive exploration of these technological advancements, their clinical implications, and the ongoing efforts to enhance pediatric radiology's safety and effectiveness.

Advantages of Photon-Counting Detector CT in Aortic Imaging

Photon-counting Computed Tomography (PCCT) is a promising imaging technique. Using detectors that count the number and energy of photons in multiple bins, PCCT offers several advantages over conventional CT, including a higher image quality, reduced contrast agent volume, radiation doses, and artifacts. Although PCCT is well established for cardiac imaging in assessing coronary artery disease, its application in aortic imaging remains limited. This review summarizes the available literature and provides an overview of the current use of PCCT for the diagnosis of aortic imaging, focusing mainly on endoleaks detection and characterization after endovascular aneurysm repair (EVAR), contrast dose volume, and radiation exposure reduction, particularly in patients with chronic kidney disease and in those requiring follow-up CT.

[Current CT developments in imaging of pancreatic diseases]

BACKGROUND

Diseases of the pancreas are often diagnosed late and can have fatal consequences for patients.

PURPOSE

Current computed tomography (CT) developments in imaging of pancreatic diseases.

MATERIALS AND METHODS

Evaluation of numerous studies, especially considering modern CT techniques such as dual-energy CT and photon-counting CT but also artificial intelligence (AI) algorithms for disease detection.

RESULTS

Spectral imaging using dual-energy CT and photon-counting CT offers numerous advantages in the detection of pancreatic disease and can thus improve diagnostic performance but also provide additional information on any therapeutic response. Likewise, advances in the development of AI algorithms are improving diagnostic performance.

CONCLUSION

In the future, we can expect increasingly improved detection of pancreatic diseases, thereby enabling patients to be treated more quickly, which will consequently result in improved outcomes.

CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease

Metabolic dysfunction-associated fatty liver disease (MAFLD), previously called metabolic nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide. The multi-factorial nature of MAFLD severity is delineated through an intricate composite analysis of the grade of activity in concert with the stage of fibrosis. Despite the preeminence of liver biopsy as the diagnostic and staging reference standard, its invasive nature, pronounced interobserver variability, and potential for deleterious effects (encompassing pain, infection, and even fatality) underscore the need for viable alternatives. We reviewed computed tomography (CT)-based methods for hepatic steatosis quantification (liver-to-spleen ratio; single-energy "quantitative" CT; dual-energy CT; deep learning-based methods; photon-counting CT) and hepatic fibrosis staging (morphology-based CT methods; contrast-enhanced CT biomarkers; dedicated postprocessing methods including liver surface nodularity, liver segmental volume ratio, texture analysis, deep learning methods, and radiomics). For dual-energy and photon-counting CT, the role of virtual non-contrast images and material decomposition is illustrated. For contrast-enhanced CT, normalized iodine concentration and extracellular volume fraction are explained. The applicability and salience of these approaches for clinical diagnosis and quantification of MAFLD are discussed.Relevance statementCT offers a variety of methods for the assessment of metabolic dysfunction-associated fatty liver disease by quantifying steatosis and staging fibrosis.Key points• MAFLD is the most prevalent chronic liver disease worldwide and is rapidly increasing.• Both hardware and software CT advances with high potential for MAFLD assessment have been observed in the last two decades.• Effective estimate of liver steatosis and staging of liver fibrosis can be possible through CT.

Clinical applications of photon counting detector CT

The X-ray detector is a fundamental component of a CT system that determines the image quality and dose efficiency. Until the approval of the first clinical photon-counting-detector (PCD) system in 2021, all clinical CT scanners used scintillating detectors, which do not capture information about individual photons in the two-step detection process. In contrast, PCDs use a one-step process whereby X-ray energy is converted directly into an electrical signal. This preserves information about individual photons such that the numbers of X-ray in different energy ranges can be counted. Primary advantages of PCDs include the absence of electronic noise, improved radiation dose efficiency, increased iodine signal and the ability to use lower doses of iodinated contrast material, and better spatial resolution. PCDs with more than one energy threshold can sort the detected photons into two or more energy bins, making energy-resolved information available for all acquisitions. This allows for material classification or quantitation tasks to be performed in conjunction with high spatial resolution, and in the case of dual-source CT, high pitch, or high temporal resolution acquisitions. Some of the most promising applications of PCD-CT involve imaging of anatomy where exquisite spatial resolution adds clinical value. These include imaging of the inner ear, bones, small blood vessels, heart, and lung. This review describes the clinical benefits observed to date and future directions for this technical advance in CT imaging. KEY POINTS: • Beneficial characteristics of photon-counting detectors include the absence of electronic noise, increased iodine signal-to-noise ratio, improved spatial resolution, and full-time multi-energy imaging. • Promising applications of PCD-CT involve imaging of anatomy where exquisite spatial resolution adds clinical value and applications requiring multi-energy data simultaneous with high spatial and/or temporal resolution. • Future applications of PCD-CT technology may include extremely high spatial resolution tasks, such as the detection of breast micro-calcifications, and quantitative imaging of native tissue types and novel contrast agents.

Characterizing the Heart and the Myocardium With Photon-Counting CT

ABSTRACT

Noninvasive cardiac imaging has rapidly evolved during the last decade owing to improvements in computed tomography (CT)-based technologies, among which we highlight the recent introduction of the first clinical photon-counting detector CT (PCD-CT) system. Multiple advantages of PCD-CT have been demonstrated, including increased spatial resolution, decreased electronic noise, and reduced radiation exposure, which may further improve diagnostics and may potentially impact existing management pathways. The benefits that can be obtained from the initial experiences with PCD-CT are promising. The implementation of this technology in cardiovascular imaging allows for the quantification of coronary calcium, myocardial extracellular volume, myocardial radiomics features, epicardial and pericoronary adipose tissue, and the qualitative assessment of coronary plaques and stents. This review aims to discuss these major applications of PCD-CT with a focus on cardiac and myocardial characterization.

Dual-Source Photon-Counting Computed Tomography-Part I: Clinical Overview of Cardiac CT and Coronary CT Angiography Applications

The photon-counting detector (PCD) is a new computed tomography detector technology (photon-counting computed tomography, PCCT) that provides substantial benefits for cardiac and coronary artery imaging. Compared with conventional CT, PCCT has multi-energy capability, increased spatial resolution and soft tissue contrast with near-null electronic noise, reduced radiation exposure, and optimization of the use of contrast agents. This new technology promises to overcome several limitations of traditional cardiac and coronary CT angiography (CCT/CCTA) including reduction in blooming artifacts in heavy calcified coronary plaques or beam-hardening artifacts in patients with coronary stents, and a more precise assessment of the degree of stenosis and plaque characteristic thanks to its better spatial resolution. Another potential application of PCCT is the use of a double-contrast agent to characterize myocardial tissue. In this current overview of the existing PCCT literature, we describe the strengths, limitations, recent applications, and promising developments of employing PCCT technology in CCT.

An experimental framework for assessing the detective quantum efficiency of spectroscopic x-ray detectors

BACKGROUND

Assessing the performance of spectroscopic x-ray detectors (SXDs) requires measurement of the frequency-dependent detective quantum efficiency (DQE). Analytical expressions of the task-based DQE and task-independent DQE of SXDs have been presented in the literature, but standardizable experimental methods for measuring them have not. The task-based DQE quantifies the efficiency with which an SXD uses the x-ray quanta incident upon it to either quantify or detect a basis material (e.g., soft tissue or bone) of interest. The task-independent DQE is akin to the conventional DQE in that it is independent of the basis material to be detected or quantified.

PURPOSE

The purpose of this paper is to develop an experimental framework to present a method for experimental analysis of the DQE of SXDs, including the task-based DQE and task-independent DQE.

METHODS

We develop methods to measure the frequency-dependent DQE for task of quantifying or detecting a perturbation in a known basis material. We also develop methods for measuring a task-independent DQE. We show that the task-based DQEs and the task-independent DQE can be measured using a modest extension of the methods prescribed by International Electrotechnical Commission (IEC). Specifically, measuring the task-independent DQE requires measuring the modulation transfer function (MTF) and noise power spectrum (NPS) of each energy-bin image, in addition to the cross NPS between energy-bin images. Measuring the task-based DQEs requires an additional measurement of the transmission fraction through a thin basis-material absorber. We implemented the developed methods using standardized IEC x-ray spectra, aluminum (Al) and polymethyl methacrylyte (PMMA) basis materials, and a cadmium telluride (CdTe) SXD equipped with two energy bins and analog charge summing (ACS) for charge-sharing suppression. We also performed a regression analysis to determine whether or not the task-independent DQE is predictive of the task-based DQEs.

RESULTS

Experimental results of the task-based DQEs were consistent with simulation results presented in the literature. In general, and as expected, ACS increased the task-based DQEs and task-independent DQE. This effect was most pronounced for quantification tasks, in some instances yielding a five-fold increase in the DQE. For both spectra, with and without ACS for charge sharing correction, the task-based DQEs were linearly related to the task-independent DQE, as demonstrated by R² -values ranging from 0.89 to 1.00.

CONCLUSIONS

We have extended experimental DQE analysis to SXDs that count photons in multiple energy bins in a single x-ray exposure. The developed framework is an extension of existing IEC methods, and provides a standardized approach to assessing the performance of SXDs.

First-generation clinical dual-source photon-counting CT: ultra-low-dose quantitative spectral imaging

OBJECTIVE

Evaluation of image characteristics at ultra-low radiation dose levels of a first-generation dual-source photon-counting computed tomography (PCCT) compared to a dual-source dual-energy CT (DECT) scanner.

METHODS

A multi-energy CT phantom was imaged with and without an extension ring on both scanners over a range of radiation dose levels (CTDI_vol 0.4-15.0 mGy). Scans were performed in different modes of acquisition for PCCT with 120 kVp and DECT with 70/Sn150 kVp and 100/Sn150 kVp. Various tissue inserts were used to characterize the precision and repeatability of Hounsfield units (HUs) on virtual mono-energetic images between 40 and 190 keV. Image noise was additionally investigated at an ultra-low radiation dose to illustrate PCCT's ability to remove electronic background noise.

RESULTS

Our results demonstrate the high precision of HU measurements for a wide range of inserts and radiation exposure levels with PCCT. We report high performance for both scanners across a wide range of radiation exposure levels, with PCCT outperforming at low exposures compared to DECT. PCCT scans at the lowest radiation exposures illustrate significant reduction in electronic background noise, with a mean percent reduction of 74% (p value ~ 10^-8) compared to DECT 70/Sn150 kVp and 60% (p value ~ 10^-6) compared to DECT 100/Sn150 kVp.

CONCLUSIONS

This paper reports the first experiences with a clinical dual-source PCCT. PCCT provides reliable HUs without disruption from electronic background noise for a wide range of dose values. Diagnostic benefits are not only for quantification at an ultra-low dose but also for imaging of obese patients.

KEY POINTS

PCCT scanners provide precise and reliable Hounsfield units at ultra-low dose levels. The influence of electronic background noise can be removed at ultra-low-dose acquisitions with PCCT. Both spectral platforms have high performance along a wide range of radiation exposure levels, with PCCT outperforming at low radiation exposures.

Photon-Counting Detector CT: Key Points Radiologists Should Know

Photon-counting detector (PCD) CT is a new CT technology utilizing a direct conversion X-ray detector, where incident X-ray photon energies are directly recorded as electronical signals. The design of the photon-counting detector itself facilitates improvements in spatial resolution (via smaller detector pixel design) and iodine signal (via count weighting) while still permitting multi-energy imaging. PCD-CT can eliminate electronic noise and reduce artifacts due to the use of energy thresholds. Improved dose efficiency is important for low dose CT and pediatric imaging. The ultra-high spatial resolution of PCD-CT design permits lower dose scanning for all body regions and is particularly helpful in identifying important imaging findings in thoracic and musculoskeletal CT. Improved iodine signal may be helpful for low contrast tasks in abdominal imaging. Virtual monoenergetic images and material classification will assist with numerous diagnostic tasks in abdominal, musculoskeletal, and cardiovascular imaging. Dual-source PCD-CT permits multi-energy CT images of the heart and coronary arteries at high temporal resolution. In this special review article, we review the clinical benefits of this technology across a wide variety of radiological subspecialties.

Model-based three-material decomposition in dual-energy CT using the volume conservation constraint

Objective. We develop a model-based optimization algorithm for ‘one-step’ dual-energy (DE) CT decomposition of three materials directly from projection measurements. Approach. Since the three-material problem is inherently undetermined, we incorporate the volume conservation principle (VCP) as a pair of equality and nonnegativity constraints into the objective function of the recently reported model-based material decomposition (MBMD). An optimization algorithm (constrained MBMD, CMBMD) is derived that utilizes voxel-wise separability to partition the volume into a VCP-constrained region solved using interior-point iterations, and an unconstrained region (air surrounding the object, where VCP is violated) solved with conventional two-material MBMD. Constrained MBMD (CMBMD) is validated in simulations and experiments in application to bone composition measurements in the presence of metal hardware using DE cone-beam CT (CBCT). A kV-switching protocol with non-coinciding low- and high-energy (LE and HE) projections was assumed. CMBMD with decomposed base materials of cortical bone, fat, and metal (titanium, Ti) is compared to MBMD with (i) fat-bone and (ii) fat-Ti bases. Main results. Three-material CMBMD exhibits a substantial reduction in metal artifacts relative to the two-material MBMD implementations. The accuracies of cortical bone volume fraction estimates are markedly improved using CMBMD, with ∼5–10× lower normalized root mean squared error in simulations with anthropomorphic knee phantoms (depending on the complexity of the metal component) and ∼2–2.5× lower in an experimental test-bench study. Significance. In conclusion, we demonstrated one-step three-material decomposition of DE CT using volume conservation as an optimization constraint. The proposed method might be applicable to DE applications such as bone marrow edema imaging (fat-bone-water decomposition) or multi-contrast imaging, especially on CT/CBCT systems that do not provide coinciding LE and HE ray paths required for conventional projection-domain DE decomposition.

Dual-Contrast Biphasic Liver Imaging With Iodine and Gadolinium Using Photon-Counting Detector Computed Tomography: An Exploratory Animal Study

PURPOSE

The aims of this study were to develop a single-scan dual-contrast protocol for biphasic liver imaging with 2 intravenous contrast agents (iodine and gadolinium) and to evaluate its effectiveness in an exploratory swine study using a photon-counting detector computed tomography (PCD-CT) system.

MATERIALS AND METHODS

A dual-contrast CT protocol was developed for PCD-CT to simultaneously acquire 2 phases of liver contrast enhancement, with the late arterial phase enhanced by 1 contrast agent (iodine-based) and the portal venous phase enhanced by the other (gadolinium-based). A gadolinium contrast bolus (gadobutrol: 64 mL, 8 mL/s) and an iodine contrast bolus (iohexol: 40 mL, 5 mL/s) were intravenously injected in the femoral vein of a healthy domestic swine, with the second injection initiated after 17 seconds from the beginning of the first injection; PCD-CT image acquisition was performed 12 seconds after the beginning of the iodine contrast injection. A convolutional neural network (CNN)-based denoising technique was applied to PCD-CT images to overcome the inherent noise magnification issue in iodine/gadolinium decomposition task. Iodine and gadolinium material maps were generated using a 3-material decomposition method in image space. A set of contrast samples (mixed iodine and gadolinium) was attached to the swine belly; quantitative accuracy of material decomposition in these inserts between measured and true concentrations was calculated using root mean square error. An abdominal radiologist qualitatively evaluated the delineation of arterial and venous vasculatures in the swine liver using iodine and gadolinium maps obtained using the dual-contrast PCD-CT protocol.

RESULTS

The iodine and gadolinium samples attached to the swine were quantified with root mean square error values of 0.75 mg/mL for iodine and 0.45 mg/mL for gadolinium from the contrast material maps derived from the denoised PCD-CT images. Hepatic arteries containing iodine and veins containing gadolinium in the swine liver could be clearly visualized. Compared with the original images, better distinctions between 2 liver phases were achieved using CNN denoising, with approximately 60% to 80% noise reduction in contrast material maps acquired with the denoised PCD-CT images compared with the original images.

CONCLUSIONS

Simultaneous biphasic liver imaging in a single multienergy PCD-CT acquisition using a dual-contrast (iodine and gadolinium) injection protocol and CNN denoising was demonstrated in a swine study, where the enhanced hepatic arteries (containing iodine) and the enhanced hepatic veins (containing gadolinium) could be clearly visualized and delineated in the swine liver.

[A Method to Obtain a Sheet-like X-ray Phantom Made from Iodine Contrast Agent]

PURPOSE

A sheet-like X-ray phantom on which thin Iodine is uniformly coated was developed to facilitate the handling of iodined objects used in any X-ray imaging studies.

METHODS

The most recommendable protocol as follows: (1) prepare undiluted 240 mg/ml Iohexol-based contrast agent and drop around 1.6 g on a horizontal surface. (2) infiltrate the agent into a membrane filter (47 mm in diameter) from the secondary side. (3) one minute later, the excess liquid components should be removed by a softy absorbent paper, and the infiltrated membrane filter should be left until substantially dried.

RESULT

The dried membrane filter can be utilized as a sheet-like X-ray phantom on which the iodine of around 2.45 mg is almost uniformly distributed per 1 cm². However, since the iodine density is slightly higher on the periphery part of the sheet, less than 80% area of the entire sheet is recommended to be used from a viewpoint of the spatial uniformity.

CONCLUSION

In the practical experiments, the X-ray attenuation factor can be controlled by changing the stacking number of the sheet, and the spatial size and form can also be designed by cutting the sheet. This capability is expected to improve the efficiency of any X-ray experiments and quality control works that requires iodined materials.

Simultaneous dual-contrast imaging using energy-integrating-detector multi-energy CT: An in vivo feasibility study

PURPOSE

To demonstrate the feasibility of simultaneous dual-contrast imaging in a large animal using a newly developed dual-source energy-integrating-detector (EID) based multi-energy computed tomography (MECT) system.

METHODS

Two imaging tasks that may have potential clinical applications were investigated: head/neck (HN) CT angiography (CTA)/CT venography (CTV) with iodine and gadolinium, and small bowel imaging with iodine and bismuth in domestic swine. Dual-source x-ray beam configurations of 70 kV+Au120/Sn120 kV and 70 kV+Au140/Sn140 kV were used for the HN-CTA/CTV and small bowel imaging studies, respectively. A test bolus scan was performed for each study. The ROIs in the carotid artery and jugular vein for HN-CTA/CTV imaging and abdominal aorta for small bowel imaging were used to determine the time-attenuation curves, based on which the timing for contrast injection and the CT scan was determined. In the HN-CTA/CTV study, a MECT scan was performed at the time point corresponding to the optimal arterial enhancement by iodine and the optimal venous enhancement by gadolinium. In the small bowel imaging study, A MECT scan was performed at the optimal time point to simultaneously capture the mesenteric arterial enhancement of iodine and the enteric enhancement of bismuth. Image-based material decomposition was performed to decompose different materials for each study. To quantitatively characterize contrast material separation and misclassification, two ROIs on left common carotid artery and left internal jugular vein in HN-CTA/CTV imaging and three ROIs on superior mesenteric artery, ileal lumen, and collapsed ileum (ileal wall) in small bowel imaging were placed to measure the mean concentration values and the standard deviations.

RESULTS

In the HN-CTA/CTV study, common carotid arteries containing iodine and internal/external jugular veins containing gadolinium were clearly delineated from each other. Fine vessels such as cephalic veins and branches of external jugular veins were noticeable but clear visualization was hindered by image noise in gadolinium-specific (CTV) images, as reviewed by a neuro radiologist. In the small bowel imaging study, the mesenteric arteries and collapsed bowel wall containing iodine and the small bowel loops containing bismuth were clearly distinctive from each other in the iodine- and bismuth-specific images after material decomposition, as reviewed by an abdominal radiologist. Quantitative analyses showed that the misclassifications between the two contrast materials were less than 1.7 mg/mL and 0.1 mg/mL for CTA/CTV and small bowel imaging studies, respectively.

CONCLUSIONS

Feasibility of simultaneous CTA/CTV imaging in head and neck with iodine and gadolinium and simultaneous imaging of arterial and enteric phases of small bowel with iodine and bismuth, using a dual-source EID-MECT system, was demonstrated in a swine study. Compared to iodine and gadolinium in CTA/CTV, better delineation and classification of iodine and bismuth in small bowel imaging were achieved mainly due to wider separation between the corresponding two K-edge energies. This article is protected by copyright. All rights reserved.

Iterative dynamic dual-energy CT algorithm in reducing statistical noise in multi-energy CT imaging

Multi-energy spectral CT has a broader range of applications with the recent development of photon-counting detectors. However, the photons counted in each energy bin decrease when the number of energy bins increases, which causes a higher statistical noise level of the CT image. In this work, we propose a novel iterative dynamic dual-energy CT algorithm to reduce the statistical noise. In the proposed algorithm, the multi-energy projections are estimated from the dynamic dual-energy CT data during the iterative process. The proposed algorithm is verified on sufficient numerical simulations and a laboratory two-energy-threshold PCD system. By applying the same reconstruction algorithm, the dynamic dual-energy CT's final reconstruction results have a much lower statistical noise level than the conventional multi-energy CT. Moreover, based on the analysis of the simulation results, we explain why the dynamic dual-energy CT has a lower statistical noise level than the conventional multi-energy CT. The reason is that: the statistical noise level of multi-energy projection estimated with the proposed algorithm is much lower than that of the conventional multi-energy CT, which leads to less statistical noise of the dynamic dual-energy CT imaging.

Spectral CT using a fine grid structure and varying x-ray incidence angle

PURPOSE

Interest in spectral computed tomography (CT) for diagnostics and therapy evaluation has been growing. Data acquisitions with distinct spectral sensitivities provide the ability to discriminate multiple materials, quantitative density estimates, and reduced artifacts due to energy dependencies. We introduce a novel spectral CT concept that includes a fine-pitch grid structure for prefiltration of the x-ray beam.

METHODS

We develop physical models for grid designs and illustrate the basic operating principles wherein small angulations of the incident x rays results significant filtration and spectral shaping of the beam. We fabricate a prototype grid with tungsten lamellae. We compare x-ray spectra induced by this filter as a function of incidence angle in both simulation students and in physical measurements. The grid is also integrated onto a CT test bench where we scanned an iodinated phantom with clinically relevant concentrations (5, 10, 20, and 50 mgI/mL) to demonstrate the ability to perform spectral CT acquisitions and material decomposition.

RESULTS

X-ray spectrometer measurements reveal diverse and controllable spectral shaping with small angle changes that are in agreement with simulation studies. Critical angles where the characteristics of the induced spectrum changes dramatically are identified. Reconstructions of projection data for two angulations separated by 2° was reconstructed and material decomposition into iodine and water images shows good agreement with the known iodine concentrations.

CONCLUSIONS

This work demonstrates the feasibility of the grid-based approach to enable spectral CT data acquisitions and accurate material decompositions. On-going and future studies will investigate the potential of this novel concept as a relatively simple upgrade to standard energy-integrating CT.

Energy-integrating-detector multi-energy CT: Implementation and a phantom study

PURPOSE

Multi-energy computed tomography (MECT) has a great potential to enable many novel clinical applications such as simultaneous multi-contrast imaging. The purpose of this study was to implement triple-beam MECT on a traditional energy-integrating-detector (EID) CT platform (EID-MECT).

METHODS

This was accomplished by mounting a z-axis split-filter (0.05 mm Au, 0.6 mm Sn) on Tube A of a dual-source EID CT scanner. With the two split x-ray beams from Tube A and the third beam from Tube B, three beams with different x-ray spectra can be simultaneously acquired. With Tube B operated at 70 or 80 kV and Tube A at 120 or 140 kV, four different triple-beam configurations were calibrated for MECT measurements: 70/Au120/Sn120, 80/Au120/Sn120, 70/Au140/Sn140, and 80/Au140/Sn140 kV. Iodine (I), gadolinium (Gd), bismuth (Bi) samples, and their mixtures were prepared for 2 three-material-decomposition tasks and 1 four-material-decomposition task. For each task, samples were placed in a water phantom and scanned using each of the four triple-beam configurations. For comparison, the same phantom was also scanned using three other dual-energy CT (DECT) or MECT technologies: twin-beam DECT (TB-DECT), dual-source DECT (DS-DECT), and photon-counting-detector CT (PCD-CT), all with optimal x-ray spectrum settings and at equal volume CT dose index (CTDIvol). The phantom for four-material decomposition (I/Gd/Bi/Water imaging) was scanned using the PCD-CT only (140 kV with 25, 50, 75, and 90 keV). Image-based material decomposition was performed to acquire material-specific images, on which the mean basis material concentrations and noise levels were measured and compared across all triple-beam configurations in EID-MECT and various DECT/MECT systems.

RESULTS

The optimal triple-beam configuration was task-dependent with 70/Au120/Sn120, 70/Au140/Sn140, and 70/Au120/Sn120 kV for I/Gd/Water, I/Bi/Water, and I/Gd/Bi/Water material decomposition tasks, respectively. At equal radiation dose level, EID-MECT provided comparable or better quantification accuracy in material-specific images for all three material decomposition tasks, compared to EID-based DECT and PCD-CT systems. In terms of noise level comparison, EID-MECT-derived material-specific images showed lower noise levels than TB-DECT and DS-DECT, but slightly higher than that from PCD-CT in I/Gd/Water imaging. For I/Bi/Water imaging, EID-MECT showed a comparable noise level to DS-DECT, and a much lower noise level than TB-DECT and PCD-CT in all material-specific images. For the four-material decomposition task involving I/Gd/Bi/Water, the bismuth-specific image derived from EID-MECT was slightly noisier, but both iodine- and gadolinium-specific images showed much lower noise levels in comparison to PCD-CT.

CONCLUSIONS

For the first time, an EID-based MECT system that can simultaneously acquire three x-ray spectra measurements was implemented on a clinical scanner, which demonstrated comparable or better imaging performance than existing DECT and MECT systems.

A detective quantum efficiency for spectroscopic X-ray imaging detectors

PURPOSE

Spectroscopic X-ray detectors (SXDs) are under development for X-ray imaging applications. Recent efforts to extend the detective quantum efficiency (DQE) to SXDs impose a barrier to experimentation and/or do not provide a task-independent measure of detector performance. The purpose of this article is to define a task-independent DQE for SXDs that can be measured using a modest extension of established DQE-metrology methods.

METHODS

We defined a task-independent spectroscopic DQE and performed a simulation study to determine the relationship between the zero-frequency DQE and the ideal-observer signal-to-noise ratio (SNR) of low-frequency soft-tissue, bone, iodine, and gadolinium signals. In our simulations, we used calibrated models of the spatioenergetic response of cadmium telluride (CdTe) and cadmium-zinc-telluride (CdZnTe) SXDs. We also measured the zero-frequency DQE of a CdTe detector with two energy bins and of a CdZnTe detector with up to six energy bins for an RQA9 spectrum and compared with model predictions.

RESULTS

The spectroscopic DQE accounts for spectral distortions, energy-bin-dependent spatial resolution, interbin spatial noise correlations, and intrabin spatial noise correlations; it is mathematically equivalent to the squared SNR per unit fluence of the generalized least-squares estimate of the height of an X-ray impulse in a uniform noisy background. The zero-frequency DQE has a strong linear relationship with the ideal-observer SNR of low-frequency soft-tissue, bone, iodine, and gadolinium signals, and can be expressed in terms of the product of the quantum efficiency and a Swank noise factor that accounts for DQE degradation due to, for example, charge sharing (CS) and electronic noise. The spectroscopic Swank noise factor of the CdTe detector was measured to be 0.81 ± 0.04 and 0.83 ± 0.04 with and without anticoincidence logic for CS suppression, respectively. The spectroscopic Swank noise factor of the CdZnTe detector operated with four energy bins was measured to be 0.82 ± 0.02 which is within 5% of the theoretical value.

CONCLUSIONS

The spectroscopic DQE defined here is (1) task-independent, (2) can be measured using a modest extension of existing DQE-metrology methods, and (3) is predictive of the ideal-observer SNR of soft-tissue, bone, iodine, and gadolinium signals. For CT applications, the combination of CS and electronic noise in CdZnTe spectroscopic detectors will degrade the zero-frequency DQE by 10 %-20 % depending on the electronic noise level and pixel size.

Spectral Photon Counting CT: Imaging Algorithms and Performance Assessment

Photon counting x-ray detectors (PCDs) with spectral capabilities have the potential to revolutionize computed tomography (CT) for medical imaging. The ideal PCD provides accurate energy information for each incident x-ray, and at high spatial resolution. This information enables material-specific imaging, enhanced radiation dose efficiency, and improved spatial resolution in CT images. In practice, PCDs are affected by non-idealities, including limited energy resolution, pulse pileup, and cross talk due to charge sharing, K-fluorescence, and Compton scattering. In order to maximize their performance, PCDs must be carefully designed to reduce these effects and then later account for them during correction and post-acquisition steps. This review article examines algorithms for using PCDs in spectral CT applications, including how non-idealities impact image quality. Performance assessment metrics that account for spatial resolution and noise such as the detective quantum efficiency (DQE) can be used to compare different PCD designs, as well as compare PCDs with conventional energy integrating detectors (EIDs). These methods play an important role in enhancing spectral CT images and assessing the overall performance of PCDs.

Photon Counting CT: Clinical Applications and Future Developments

The use of a photon counting detector in CT (PCD CT) is currently the subject of intense investigation and development. In this review article, we will describe potential clinical applications of this technology with a particular focus on the experience of our own institution with a prototype PCD CT scanner. PCDs have three primary advantages over conventional, energy integrating detectors (EIDs): they provide spectral information without need for a dedicated dual energy protocol; they are immune to electronic noise; and they can be made very high resolution without significant compromises to quantum efficiency. These advantages translate into several clinical applications. Metal artifacts, beam hardening artifacts, and noise streaks from photon starvation can be better mitigated using PCD CT. Certain incidental findings can be better characterized using the spectral information from PCD CT. High-contrast, high-resolution structures such as the temporal bone can be better visualized using PCD CT and at greatly reduced dose. We also discuss new possibilities on the horizon, including new contrast agents, and how anticipated improvements in PCD CT will translate to performance in these applications.

Simultaneous Dual-Contrast Imaging of Small Bowel With Iodine and Bismuth Using Photon-Counting-Detector Computed Tomography: A Feasibility Animal Study

OBJECTIVES

Dual-energy and multienergy computed tomography (DECT/MECT) has the potential to simultaneously visualize two contrast agents in the small bowel: arterial enhancement of iodine in the bowel wall and enteric enhancement of bismuth in the bowel lumen. The purpose of this study was to explore its feasibility in a swine study using a research whole-body photon-counting-detector (PCD) computed tomography (CT) system.

MATERIALS AND METHODS

A phantom study was initially performed to evaluate the quantification accuracy of iodine and bismuth separation from a single PCD-CT scan, which also served as the calibration reference for material decomposition of in vivo swine PCD-CT data. In the animal study, a test bolus scan was first performed to determine the time-attenuation curve for the arterial enhancement, based on which the timing of the PCD-CT dual-contrast scan was determined. A 600 mL homogeneous bismuth-saline solution (180 mL Pepto-Bismol + 420 mL normal saline) was orally administered to the pig using esophageal intubation. Approximately 1 hour after bismuth administration, 40 mL iodine contrast (Omnipaque 350, 5 mL/s) was injected intravenously. A PCD-CT scan was performed 13 seconds after the initiation of the contrast injection to simultaneously capture the arterial enhancement of iodine and the enteric enhancement of bismuth. To provide optimal material separation and quantification, all PCD-CT scans in both phantom and animal studies were operated at 140 kV with 4 energy thresholds of 25, 50, 75, and 90 keV.

RESULTS

Using a generic image-based material decomposition method, the iodine and bismuth samples were successfully delineated and quantified in the phantom images with a root-mean-square-error of 1.32 mg/mL in iodine measurement and 0.64 mg/mL in bismuth measurement. In the pig study, the enhancing bowel wall containing iodine and the small bowel loop containing bismuth were not differentiable in the original PCD-CT images. However, they were clearly distinctive from each other in the iodine- and bismuth-specific images after material decomposition, as reviewed by an abdominal radiologist. In addition, quantitative analysis showed that the misclassification between the two contrast materials was less than 1.0 mg/mL.

CONCLUSIONS

Our study demonstrated the feasibility of simultaneous imaging of iodine and bismuth in small bowel of swine using PCD-CT.

Threshold-dependent iodine imaging and spectral separation in a whole-body photon-counting CT system

OBJECTIVE

To evaluate the dual-energy (DE) performance and spectral separation with respect to iodine imaging in a photon-counting CT (PCCT) and compare it to dual-source CT (DSCT) DE imaging.

METHODS

A semi-anthropomorphic phantom extendable with fat rings equipped with iodine vials is measured in an experimental PCCT. The system comprises a PC detector with two energy bins (20 keV, T) and (T, eU) with threshold T and tube voltage U. Measurements using the PCCT are performed at all available tube voltages (80 to 140 kV) and threshold settings (50-90 keV). Further measurements are performed using a conventional energy-integrating DSCT. Spectral separation is quantified as the relative contrast media ratio R between the energy bins and low/high images. Image noise and dose-normalized contrast-to-noise ratio (CNRD) are evaluated in resulting iodine images. All results are validated in a post-mortem angiography study.

RESULTS

R of the PC detector varies between 1.2 and 2.6 and increases with higher thresholds and higher tube voltage. Reference R of the EI DSCT is found as 2.20 on average overall phantoms. Maximum CNRD in iodine images is found for T = 60/65/70/70 keV for 80/100/120/140 kV. The highest CNRD of the PCCT is obtained using 140 kV and is decreasing with decreasing tube voltage. All results could be confirmed in the post-mortem angiography study.

CONCLUSION

Intrinsically acquired DE data are able to provide iodine images similar to conventional DSCT. However, PCCT thresholds should be chosen with respect to tube voltage to maximize image quality in retrospectively derived image sets.

KEY POINTS

• Photon-counting CT allows for the computation of iodine images with similar quality compared to conventional dual-source dual-energy CT. • Thresholds should be chosen as a function of the tube voltage to maximize iodine contrast-to-noise ratio in derived image sets. • Image quality of retrospectively computed image sets can be maximized using optimized threshold settings.

Differentiation of Crystals Associated With Arthropathies by Spectral Photon-Counting Radiography: A Proof-of-Concept Study

OBJECTIVES

The aims of this study were to test whether spectral photon-counting radiography (SPCR) is able to identify and distinguish different crystals associated with arthropathies in vitro and to validate findings in a gouty human third toe ex vivo.

MATERIALS AND METHODS

Industry-standard calibration rods of calcium pyrophosphate, calcium hydroxyapatite (HA), and monosodium urate (MSU) were scanned with SPCR in an experimental setup. Each material was available at 3 different concentrations, and a dedicated photon-counting detector was used for SPCR, whereas validation scans were obtained on a clinical dual-energy computed tomography (DECT) scanner. Regions of interest were placed on SPCR images and consecutive DECT images to measure x-ray attenuation characteristics, including effective atomic numbers (Zeff). Statistical tests were performed for differentiation of Zeff between concentrations, materials, and imaging modalities. In addition, a third toe from a patient with chronic gouty arthritis was scanned with SPCR and DECT for differentiation of MSU from HA.

RESULTS

In both SPCR and DECT, significant differences in attenuation and Zeff values were found for different concentrations among (P < 0.001) and between different materials (P < 0.001). Overall, quantitative measurements of Zeff did not differ significantly between SPCR- and DECT-derived measurements (P = 0.054-0.412). In the human cadaver toe, gouty bone erosions were visible on standard grayscale radiographic images; however, spectral image decomposition revealed the nature and extent of MSU deposits and was able to separate it from bone HA by Zeff.

CONCLUSIONS

Identification and differentiation of different crystals related to arthropathies are possible with SPCR at comparable diagnostic accuracy to DECT. Further research is needed to assess diagnostic accuracy and clinical usability in vivo.

Computed tomography with a full FOV photon-counting detector in a clinical setting, the first experience

OBJECTIVES

to assess the feasibility of CT with an integrated photon-counting-detector system (PC-CT) in the body imaging of clinical patients.

METHODS

120 examinations using photon counting detector CT were evaluated in six groups: 1/ a standard-dose lung, 2/ low-dose lung, 3/ ultra-high resolution (UHR) lung, 4/ standard-dose abdominal, 5/ lower-dose abdominal, 6/ UHR abdominal CTA. All CT examinations were performed on a single-source prototype device equipped with a photon counting detector covering a 50 cm scan field of view. Standard dose examinations were performed with the use of detector element size of 0.4 mm, ultra-high-resolution examinations with the detector element size of 0.2 mm, respectively. The stability of the system during imaging was tested. The diagnostic quality of the acquired images was assessed based on the imaging of key structures and the noise level in five-point scale, the effective dose equivalent, dose length product and noise level, and also relation to body mass index and body surface area were compared with three similar groups of CT images made with energy integrating high end scanner. The parameters were evaluated using Wilcoxon test for independent samples, the independence was tested using Kruskal-Wallis test.

RESULTS

When PC-CT images radiation dose is compared with the similar imaging using energy integrating CT, the PC-CT shows lower dose in ultra-high resolution mode, the dose is significantly lower (p < 0.0001), the standard dose examinations were performed with the comparable radiation doses. PC-CT exhibited the significantly higher ratio between parenchyma signal and background noise both in lung and in abdominal imaging (p < 0.0001).

CONCLUSIONS

PC-CT showed imaging stability and excellent diagnostic quality at dose values that are comparable or better to the quality of energy integrating CT, the better signal and improved resolution is most important advantage of photon counting detector CT over energy integrating detector CT.

Review of Technical Advancements and Clinical Applications of Photon-counting Computed Tomography in Imaging of the Thorax

Photon-counting computed tomography (CT) is a developing technology that has the potential to address some limitations of CT imaging and bring about improvements and potentially new applications to this field. Photon-counting detectors have a fundamentally different detection mechanism from conventional CT energy-integrating detectors that can improve dose efficiency, spatial resolution, and energy-discrimination capabilities. In the past decade, promising human studies have been reported in the literature that have demonstrated benefits of this relatively new technology for various clinical applications. In this review, we provide a succinct description of the photon-counting detector technology and its detection mechanism in comparison with energy-integrating detectors in a manner understandable for clinicians and radiologists, introduce benefits and some of the existing challenges present in this technology, and provide an overview of the current status and potential clinical applications of this technology in imaging of the thorax by providing example images acquired with an investigational whole-body photon-counting CT scanner.

Diagnostic Performance of Different Simulated Low-Dose Levels in Patients with Suspected Cervical Abscess Using a Third-Generation Dual-Source CT Scanner

The aim of this study was to investigate the effects of dose reduction on diagnostic accuracy and image quality of cervical computed tomography (CT) in patients with suspected cervical abscess. Forty-eight patients (mean age 45.5 years) received a CT for suspected cervical abscess. Low-dose CT (LDCT) datasets with 25%, 50%, and 75% of the original dose were generated with a realistic simulation. The image data were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) (strengths 3 and 5). A five-point Likert scale was used to assess subjective image quality and diagnostic confidence. The signal-to-noise ratio (SNR) of the sternocleidomastoid muscle and submandibular gland and the contrast-to-noise ratio (CNR) of the sternocleidomastoid muscle and submandibular glandular fat were calculated to assess the objective image quality. Diagnostic accuracy was calculated for LDCT using the original dose as the reference standard. The prevalence of cervical abscesses was high (72.9%) in the cohort; the mean effective dose for all 48 scans was 1.8 ± 0.8 mSv. Sternocleidomastoid and submandibular SNR and sternocleidomastoid muscle fat and submandibular gland fat CNR increased with higher doses and were significantly higher for ADMIRE compared to FBP, with the best results in ADMIRE 5 (all p < 0.001). Subjective image quality was highest for ADMIRE 5 at 75% and lowest for FBP at 25% of the original dose (p < 0.001). Diagnostic confidence was highest for ADMIRE 5 at 75% and lowest for FBP at 25% (p < 0.001). Patient-based diagnostic accuracy was high for all LDCT datasets, down to 25% for ADMIRE 3 and 5 (sensitivity: 100%; specificity: 100%) and lower for FBP at 25% dose reduction (sensitivity: 88.6-94.3%; specificity: 92.3-100%). The use of a modern dual-source CT of the third generation and iterative reconstruction allows a reduction in the radiation dose to 25% (0.5 mSv) of the original dose with the same diagnostic accuracy for the assessment of neck abscesses.

Optimization of the differentiation and quantification of high-Z nanoparticles incorporated in medical devices for CT-guided interventions

PURPOSE

Material differentiation has been made possible using dual-energy computed tomography (DECT), in which the unique, energy-dependent attenuating characteristics of materials can provide new diagnostic information. One promising application is the clinical integration of biodegradable polymers as temporary implantable medical devices impregnated with high-atomic number (high-Z) materials. The purpose of this study was to explore the incorporation of high atomic number (high-Z) contrast materials in a bioresorbable inferior vena cava filter for advanced CT-based monitoring of its location and differentiating from surrounding materials.

MATERIALS AND METHODS

Imaging optimization and calibration studies were performed using a body phantom. The dual-energy CT (DECT) ratios for iron, zirconium, barium, gadolinium, ytterbium, tantalum, tungsten, gold, and bismuth were generated for peak kilovoltage combinations of 80/150Sn, 90/150Sn, and 100/150Sn kVp in dual-source CT via linear regression of the CT numbers at low and high energies. A secondary calibration of the material map to the nominal material concentration was generated to correct for use of materials other than iodine. CT number was calibrated to the material concentration based on single-energy CT (SECT) with additional filtration (150Sn kVp). These quantification methods were applied to monitoring of biodegradable inferior vena cava filters (IVCFs) made of braided poly(p-dioxanone) sutures infused with ultrasmall bismuth nanoparticles (BiNPs) implanted in an adult domestic pig.

RESULTS

Qualitative material differentiation was optimal for high-Z (>73) contrast agents in DECT. However, quantification became nonlinear and inaccurate as the K-edge of the material increased. Using the high-energy (150Sn kVp) data component as a SECT scan, the linearity of quantification curves was maintained with lower limits of detection than with DECT. Among the materials tested, bismuth had optimal differentiation from iodine in DECT while maintaining increased contrast in high-energy SECT for quantification (11.5% error). Coating the IVCF with BiNPs resulted in markedly greater radiopacity (maximum CT number, 2028 HU) than that of an uncoated IVCF (maximum CT number, 127 HU). Using DECT imaging and processing, the BiNP-IVCF could be clearly differentiated from iodine contrast injected into the inferior vena cava of the pig.

CONCLUSIONS

These findings may improve widespread integration of medical devices incorporated with high-Z materials into the clinic, where technical success, possible complications, and device integrity can be assessed intraoperatively and postoperatively via DECT imaging.

Bone Mineral Density Quantification from Localizer Radiographs: Accuracy and Precision of Energy-integrating Detector CT and Photon-counting Detector CT

Background Bone mineral density (BMD) could be derived from CT localizer radiographs and could potentially enable opportunistic osteoporosis screening. Purpose To assess the accuracy and precision of BMD measurement using two localizer radiographs obtained with energy-integrating detector CT and a single localizer radiograph obtained with photon-counting detector CT. Materials and Methods A calibration phantom and a porcine phantom with lumbar vertebrae were imaged with a dual-energy x-ray absorptiometry (DXA) scanner, a clinical energy-integrating detector CT scanner, and a prototype photon-counting detector CT scanner. Two localizer radiographs at different combinations of tube voltages were obtained with energy-integrating detector CT, and one localizer radiograph was obtained with photon-counting detector CT using different energy thresholds. BMD was calculated for all three approaches and compared with the known specifications in the calibration phantom. In the animal phantom, BMDs from both CT systems were compared with those from the DXA scanner (the reference standard). Accuracy was defined as the measurement error of BMD (ΔBMD), and precision was defined as the coefficient of variation (in percentage). Radiation doses were estimated. Nonparametric tests were applied. Results In the calibration phantom, ΔBMD was smaller with both CT systems compared with the DXA scanner (both P < .05). ΔBMD ranged from -5% to -1.8% for DXA, from -2.3% to -1.7% for energy-integrating detector CT, and from -1.6% to 1.6% for photon-counting detector CT. Precision (range, 0.3%-2.8%) was high for both CT systems. In the animal phantom, ΔBMD ranged from -0.6% to 0.1% for energy-integrating detector CT and from -0.1% to 0.6% for photon-counting detector CT, with no significant differences between CT systems (P = .65). The dose-area product in the animal phantom was 4.6 cGy ∙ cm² for DXA, 3.5-11.5 cGy ∙ cm² for energy-integrating detector CT, and 7.2-11.2 cGy ∙ cm² for photon-counting detector CT, depending on tube voltage and energy threshold combination. Conclusion Experimental evidence suggests that bone mineral density measurements are accurate and precise using two localizer radiographs at different tube voltages from energy-integrating detector CT and a single localizer radiograph with different energy thresholds from photon-counting detector CT. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Pourmorteza in this issue.

Multi-energy CT imaging for large patients using dual-source photon-counting detector CT

Multi-energy CT imaging of large patients with conventional dual-energy (DE)-CT using an energy-integrating-detector (EID) is challenging due to photon starvation-induced image artifacts, especially in lower tube potential (80-100 kV) images. Here, we performed phantom experiments to investigate the performance of DECT for morbidly obese patients, using an iodine and water material decomposition task as an example, on an emulated dual-source (DS)-photon-counting-detector (PCD)-CT, and compared its performance with a clinical DS-EID-CT. An abdominal CT phantom with iodine inserts of different concentrations was wrapped with tissue-equivalent gel layers to emulate a large patient (50 cm lateral size). The phantom was scanned on a research whole-body single-source (SS)-PCD-CT (140 kV tube potential), a DS-PCD-CT (100/Sn140 kV; Sn140 indicates 140 kV with Sn filter), and a clinical DS-EID-CT (100/Sn140 kV) with the same radiation dose. Phantom scans were repeated five times on each system. The DS-PCD-CT acquisition was emulated by scanning twice on the SS-PCD-CT using different tube potentials. The multi-energy CT images acquired on each system were then reconstructed, and iodine- and water-specific images were generated using material decomposition. The root-mean-square-error (RMSE) between true and measured iodine concentrations were calculated for each system and compared. The images acquired on the DS-EID-CT showed severe artifacts, including ringing, reduced uniformity, and photon starvation artifacts, especially for low-energy images. These were largely reduced in DS-PCD-CT images. The CT number difference that was measured using regions-of-interest across field-of-view were reduced from 20.3 ± 0.9 (DS-EID-CT) to 2.5 ± 0.4 HU on DS-PCD-CT, showing improved image uniformity using DS-PCD-CT. Iodine RMSE was reduced from 3.42 ± 0.03 mg ml^-1 (SS-PCD-CT) and 2.90 ± 0.03 mg ml^-1 (DS-EID-CT) to 2.39 ± 0.05 mg ml^-1 using DS-PCD-CT. DS-PCD-CT out-performed a clinical DS-EID-CT for iodine and water-based material decomposition on phantom emulating obese patients by reducing image artifacts and improving iodine quantification (RMSE reduced by 20%). With DS-PCD-CT, multi-energy CT can be performed on large patients that cannot be accommodated with current DECT.

Grating-based Spectral CT using Small Angle X-ray Beam Deflections

Interest in spectral CT for diagnostics and therapy evaluation has been growing. Acquisitions of data from distinct energy spectra provide, among other advantages, quantitative density estimations for multiple materials. We introduce a novel spectral CT concept that includes a fine-pitch grating for prefiltration of the x-ray beam. The attenuation behavior of this grating changes significantly if x-rays are slightly angled in relation to the grating structures. To apply such an angle (i.e. switch between the different filtrations) we propose a fast, controllable, and precise solution by moving the focal spot of the x-ray tube. In this work, we performed preliminary evaluations with a grating prototype on a CT test bench. Our results include x-ray spectrometer measurements that reveal diverse and controllable spectral shaping between 4° and 6° for a specific grating design. Additional experiments with a contrast agent phantom illustrated the capability to decompose clinically relevant iodine concentrations (5, 10, 20, and 50mg/mL) - demonstrating the feasibility of the grating-based approach. Ongoing and future studies will investigate the potential of this novel concept as a relatively simple upgrade to standard energy-integrating CT.

Multi-energy computed tomography and material quantification: Current barriers and opportunities for advancement

Computed tomography (CT) technology has rapidly evolved since its introduction in the 1970s. It is a highly important diagnostic tool for clinicians as demonstrated by the significant increase in utilization over several decades. However, much of the effort to develop and advance CT applications has been focused on improving visual sensitivity and reducing radiation dose. In comparison to these areas, improvements in quantitative CT have lagged behind. While this could be a consequence of the technological limitations of conventional CT, advanced dual-energy CT (DECT) and photon-counting detector CT (PCD-CT) offer new opportunities for quantitation. Routine use of DECT is becoming more widely available and PCD-CT is rapidly developing. This review covers efforts to address an unmet need for improved quantitative imaging to better characterize disease, identify biomarkers, and evaluate therapeutic response, with an emphasis on multi-energy CT applications. The review will primarily discuss applications that have utilized quantitative metrics using both conventional and DECT, such as bone mineral density measurement, evaluation of renal lesions, and diagnosis of fatty liver disease. Other topics that will be discussed include efforts to improve quantitative CT volumetry and radiomics. Finally, we will address the use of quantitative CT to enhance image-guided techniques for surgery, radiotherapy and interventions and provide unique opportunities for development of new contrast agents.

Investigation of imaging properties of novel contrast agents based on gold, silver and bismuth nanoparticles in spectral computed tomography using Monte Carlo simulation

In the present paper, some imaging properties of nanoparticles-based contrast agents including gold, bismuth, and silver were assessed and compared with conventional (iodinated) contrast agent in spectral computed tomography (CT). A spectral CT scanner with photon-counting detectors (PCD) and 6 energy bins was simulated using the Monte Carlo (MC) simulation method. The nanoparticles were designed with a diameter of 50 nm at concentrations of 2, 4, and 8 mg/ml. Water-filled cylindrical phantom was modeled with a diameter of 10 cm containing a hole with a diameter of 5 cm in its center, where was filled with contrast agents. The MC results were used to reconstruct images. Image reconstruction was accomplished with the filtered back-projection (FBP) method with hamming filter and linear interpolation method. CT number and contrast-to-noise ratio (CNR) of all studied contrast materials were calculated in spectral images. The simulations indicated that nanoparticle-based contrast agents have a higher CT number and CNR than the iodinated contrast agent at the same concentration and for all energy bins. In general, gold nanoparticles produced the highest CT number and CNR compared to silver and bismuth nanoparticles at the same concentration. However, at low energies (below 80 keV), silver nanoparticles performed similarly to gold nanoparticles and at high energies (120 keV), bismuth nanoparticles can be a good substitute for gold nanoparticles.

Radiation dose efficiency of multi-energy photon-counting-detector CT for dual-contrast imaging

Compared to traditional multi-scan single-energy CT (SECT), one potential advantage of single-scan multi-energy CT (MECT) proposed for simultaneous imaging of multiple contrast agents is the radiation dose reduction. This phantom study aims to rigorously evaluate whether the radiation dose can truly be reduced in a single-scan MECT protocol (MECT_1s) in biphasic liver imaging with iodine and gadolinium, and small bowel imaging with iodine and bismuth, compared to traditional two-scan SECT protocols (SECT_2s). For MECT_1s, mixed iodine/gadolinium samples were prepared corresponding to late arterial/portal-venous phase for biphasic liver imaging. Mixed iodine/bismuth samples were prepared representing the arterial/enteric enhancement for small bowel imaging. For SECT_2s, separate contrast samples were prepared to mimic separate scans in arterial/venous phase and arterial/enteric enhancement. Samples were placed in a 35 cm wide water phantom and scanned by a research whole-body photon-counting-detector-CT (PCD-CT) system ('chess' mode). MECT images were acquired with optimized kV/threshold settings for each imaging task, and SECT images were acquired at 120 kV. Total CTDIvol was matched for the two protocols. Image-based three-material decomposition was employed in MECT_1s to determine the basis material concentration values, which were converted to CT numbers at 120 kV (i.e. virtual SECT images) to compare with the SECT images directly acquired with SECT_2s. The noise difference between the SECT and the virtual SECT images was compared to evaluate the dose efficiency of MECT_1s. Compared to SECT_2s, MECT_1s was not dose efficient for both imaging tasks. The amount of noise increase is highly task dependent, with noise increased by 203%/278% and 110%/82% in virtual SECT images for iodine/gadolinium and iodine/bismuth quantifications, respectively, corresponding to dose increase by 819%/1328% and 340%/230% in MECT_1s to achieve the same image noise level. MECT with the current PCD-CT technique requires higher radiation dose than SECT to achieve the same image quality.