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Image Quality and Radiation Dose of CTPA With Iodine Maps: A Prospective Randomized Study of High-Pitch Mode Photon-Counting Detector CT Versus Energy-Integrating Detector CT.

Background: Dual-energy CT pulmonary angiography (CTPA) with energy-integrating detector (EID) technology is limited by inability to use high-pitch technique. Objective: To compare image quality of anatomic images and iodine maps between high-pitch PCD CTPA and dual-energy EID CTPA. Methods: This prospective study included 117 patients (median age, 65 years; 70 men, 47 women) who underwent CTPA to evaluate for pulmonary embolism between March 2022 and November of 2022. Fifty-eight patients were randomized to undergo PCD CTPA (pitch, 2.0), and 59 to undergo EID CTPA (pitch, 0.55). For each examination, 120-kV polychromatic images, 60-keV virtual monogenetic images (VMI), and iodine maps were reconstructed. One radiologist measured CNR and SNR. Three radiologists independently assessed subjective image quality (1-4 scale; 1=highest quality). Radiation dose was recorded. Results: SNR and CNR were higher for PCD CTPA than EID CTPA for polychromatic images and VMI for all assessed vessels other than left upper lobe artery. For example, for PCD CTPA versus EID CTPA, right lower lobe artery for polychromatic images had SNR of 34.5 versus 28.0 (p=.003) and CNR of 29.2 versus 24.4 (p=.001), and for VMI had SNR of 43.2 versus 32.7 (p=.005) and CNR of 37.4 versus 29.3 (p=.002). Median image quality score for polychromatic images and VMI for both scanners for readers 1 and 2 was 1, although distributions indicated significantly better scores for PCD CTPA than EID CTPA for polychromatic images for reader 1 (p=.02) and reader 2 (p=.005), and for VMI for reader 1 (p=.001) and reader 2 (p=.006). Image quality of anatomic image sets was not different between PCD CTPA and EID CTPA for reader 3 (p>.05). Image quality of iodine maps was not different between PCD CTPA and EID CTPA for any reader (p>.05). For PCD CTPA versus EID CTPA, CTDIvol was 3.9 mGy versus 4.5 mGy (p=.03); DLP was 123.5 mGy*cm versus 157.0 mGy*cm (p<.001). Conclusions: High-pitch PCD CTPA provided anatomic images with better subjective and objective image quality versus dual-energy EID CTPA, with lower radiation dose. Iodine maps showed no significant difference in image quality between scanners. Clinical Impact: CTPA may benefit from PCD CT technique.

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