A new advanced form of computed tomography (CT) imaging called photon counting computed tomography (PCCT) offers better quality cardiovascular imaging at a similar radiation dose compared to dual-source CT (DSCT) in infants with suspected heart defects. study published today, May 23, in Radiology, a journal of the Radiological Society of North America (RSNA).
Congenital heart defects are the main cause of morbidity and mortality in the neonatal period, occurring in up to one percent of live births. Of these, approximately 25% are critical defects requiring surgery within the first month after birth. A comprehensive examination, including ultrasound, MRI and CT scans, is usually required to plan the surgery and create virtual and printed 3D reconstructions of the heart.
“Infants and neonates with suspected congenital heart defects are a technically challenging group of patients for any imaging modality, including CT,” said Timm Dirrichs, M.D., senior physician and specialist in cardiothoracic radiology at the Department of Diagnostic and Interventional Radiology at RWTH Aachen University. Aachen Hospital, Germany. “There is a substantial clinical need to improve cardiac CT in this vulnerable group.” It is essential to carefully map the individual cardiac anatomy and possible surgical pathways using the highest possible diagnostic standards.”
PCCT is an emerging imaging technique that precisely counts and measures the energy of incoming X-ray photons. Compared to DSCT technology, PCCT offers higher image resolution and/or reduced radiation doses, which is of particular interest when imaging children. The PCCT technique has already been shown to improve cardiovascular CT imaging in adults. However, there is a lack of data on newborns and young children.
“Our objective was to evaluate the image quality of first-generation photon-counting CT for cardiac imaging in children with suspected heart defects compared to third-generation dual-source CT (DSCT) and compare the associated radiation exposure,” says Dr. Dirrichs said.
The research team analyzed existing clinical CT scans of 113 children who underwent contrast-enhanced PCCT (30 infants), DSCT (83 infants), or PCCT and DSCT (one infant) of the heart and thoracic aorta between January 2019 and October 2022. the group consisted of 55 girls/58 boys (mean age 66 days).
The researchers found that the PCCT images were sharper, with less image noise and more contrast than the DSCT images. The mean overall visual image quality rating was higher for PCCT versus DSCT at similar radiation dose. More than 97% of PCCT images were of at least diagnostic quality, compared with 77% of DSCT images.
“In our study, none of the PCCT scans showed poor image quality, and only a few had limited or moderate quality,” said Dr. Dirrichs.
He noted that of the DSCT images, nearly one quarter were of limited or nondiagnostic quality and 40% were of moderate quality.
“PCCT is a promising method that can improve diagnostic image quality and efficiency compared to DSCT imaging,” said Dr. Dirrichs. “This higher efficiency can be used to reduce radiation dose at a given level of image quality or to improve image quality at a given level of radiation.”
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