Potential of photon-counting detector CT technology for contrast medium reduction in portal venous phase thoracoabdominal CT

Abstract Objectives To compare image quality and iodine attenuation intra-individually in portal venous phase photon-counting detector CT (PCD-CT) scans using protocols with different contrast medium (CM) volume. Materials and methods A prospectively acquired patient cohort between 04/2021 and 11/2023 was retrospectively screened if patients had the following combination of portal venous phase thoracoabdominal CT scans: (a) PCD-CT with 120 mL CM volume (PCD-CT 120 mL ), (b) PCD-CT with 100 mL CM volume (PCD-CT 100 mL ), and (c) prior energy-integrating detector CT (EID-CT) with 120 mL CM volume. On PCD-CT, virtual monoenergetic image (VMI) reconstructions at 70 keV were applied for both groups as well as additional VMI at 60 keV for PCD‑CT 100 mL . Quantitative analyses including signal-to-noise (SNR) and contrast-to-noise ratios (CNR) and qualitative analyses were performed using a mixed linear effects model. Results The final study cohort comprised 49 patients (mean age 67 [31–86] years, 12 female). Comparison to EID-CT was available in 33 patients. In standard 70 keV VMI reconstructions, PCD-CT 100 mL was non-inferior to PCD-CT 120 mL as well as to EID-CT 120 mL for CNR in abdominal organs (all p > 0.050). The mixed linear effects model revealed significant differences between contrast volume groups for both contrast enhancement and image quality ratings. PCD-CT 100 mL/70 keV demonstrated the smallest deviation from optimal contrast enhancement (−0.306, p < 0.001). Conclusion In portal venous phase thoracoabdominal PCD-CT, a nearly 17% reduction in CM was achievable while maintaining subjective and objective image quality compared to prior higher CM volume PCD-CT scans within the same patients and still surpassing image quality of previous exams on an EID-CT system. Key Points Question How do image quality and iodine attenuation intra-individually compare in portal venous phase photon-counting detector CT (PCD-CT) scans using protocols with different contrast medium volume. Findings PCD-CT scans exhibit superior quantitative and qualitative image quality compared to energy-integrating detector-CT acquisitions and are not negatively affected by contrast volume reductions up to 17%. Clinical relevance This study provides further evidence that PCD-CT enables a considerable reduction in iodine dose for portal venous phase acquisition, benefiting both patients and healthcare system costs.