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Impact of ultra-high-resolution imaging of the lungs on perceived diagnostic image quality using photon-counting CT

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A Commentary to this article was published on 06 September 2023

Abstract

Objectives

To compare clinical image quality and perceived impact on diagnostic interpretation of chest CT findings between ultra-high-resolution photon-counting CT (UHR-PCCT) and conventional high-resolution energy-integrating-detector CT (HR-EIDCT) using visual grading analysis (VGA) scores.

Materials and methods

Fifty patients who underwent a UHR-PCCT (matrix 512 × 512, 768 × 768, or 1024 × 1024; FOV average 275 × 376 mm, 120 × 0.2 mm; focal spot size 0.6 × 0.7 mm) between November 2021 and February 2022 and with a previous HR-EIDCT within the last 14 months were included. Four readers evaluated central and peripheral airways, lung vasculature, nodules, ground glass opacities, inter- and intralobular lines, emphysema, fissures, bullae/cysts, and air trapping on PCCT (0.4 mm) and conventional EIDCT (1 mm) via side-by-side reference scoring using a 5-point diagnostic quality score. The median VGA scores were compared and tested using one-sample Wilcoxon signed rank tests with hypothesized median values of 0 (same visibility) and 2 (better visibility on PCCT with impact on diagnostic interpretation) at a 2.5% significance level.

Results

Almost all lung structures had significantly better visibility on PCCT compared to EIDCT (p < 0.025; exception for ground glass nodules (N = 2/50 patients, p = 0.157)), with the highest scores seen for peripheral airways, micronodules, inter- and intralobular lines, and centrilobular emphysema (mean VGA > 1). Although better visibility, a perceived difference in diagnostic interpretation could not be demonstrated, since the median VGA was significantly different from 2.

Conclusion

UHR-PCCT showed superior visibility compared to HR-EIDCT for central and peripheral airways, lung vasculature, fissures, ground glass opacities, macro- and micronodules, inter- and intralobular lines, paraseptal and centrilobular emphysema, bullae/cysts, and air trapping.

Clinical relevance statement

UHR-PCCT has emerged as a promising technique for thoracic imaging, offering improved spatial resolution and lower radiation dose. Implementing PCCT into daily practice may allow better visibility of multiple lung structures and optimization of scan protocols for specific pathology.

Key Points

• The aim of this study was to verify if the higher spatial resolution of UHR-PCCT would improve the visibility and detection of certain lung structures and abnormalities.

• UHR-PCCT was judged to have superior clinical image quality compared to conventional HR-EIDCT in the evaluation of the lungs. UHR-PCCT showed better visibility for almost all tested lung structures (except for ground glass nodules).

• Despite superior image quality, the readers perceived no significant impact on the diagnostic interpretation of the studied lung structures and abnormalities.

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Abbreviations

COVID:

Coronavirus disease

CPFE:

Combined pulmonary fibrosis and emphysema

CT:

Computed tomography

EIDCT:

Energy-integrating-detector CT

ILD:

Interstitial lung disease

PACS:

Picture Archiving and Communication System

PCCT:

Photon-counting CT

VGA:

Visual grading analysis

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Herestraat 49 3000, Louvain, Belgium

    Valerie Van Ballaer, Adriana Dubbeldam, Emanuele Muscogiuri, Lesley Cockmartin, Hilde Bosmans, Walter Coudyzer, Johan Coolen & Walter de Wever

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  1. Valerie Van Ballaer
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  2. Adriana Dubbeldam
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  3. Emanuele Muscogiuri
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  4. Lesley Cockmartin
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  5. Hilde Bosmans
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  6. Walter Coudyzer
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  7. Johan Coolen
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  8. Walter de Wever
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Corresponding author

Correspondence to Valerie Van Ballaer.

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Guarantor

The scientific guarantor of this publication is Walter De Wever.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Lesley Cockmartin, one of the authors, has significant statistical expertise and kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained. The Ethics Committee Research of University Hospitals Leuven approved the study.

Study subjects or cohorts overlap

No study subjects or cohort overlap reported.

Methodology

• combined prospective and retrospective

• observational study

• performed at one institution

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Van Ballaer, V., Dubbeldam, A., Muscogiuri, E. et al. Impact of ultra-high-resolution imaging of the lungs on perceived diagnostic image quality using photon-counting CT. Eur Radiol 34, 1895–1904 (2024). https://doi.org/10.1007/s00330-023-10174-5

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  • DOI: https://doi.org/10.1007/s00330-023-10174-5

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