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Diagnosis of acute pulmonary embolism: when photon-counting-detector CT replaces energy-integrating-detector CT in daily routine

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Abstract

Purpose

To compare the diagnostic approach of acute pulmonary embolism (PE) with photon-counting-detector CT (PCD-CT) and energy-integrating-detector CT (EID-CT).

Materials and methods

Two cohorts underwent CT angiographic examinations with EID-CT (Group 1; n = 158) and PCD-CT (Group 2; n = 172), (b) with two options in Group 1, dual energy (Group 1a) or single energy (Group 1b) and a single option in Group 2 (spectral imaging with single source).

Results

In Group 2, all patients benefited from spectral imaging, only accessible to 105 patients (66.5%) in Group 1, with a mean acquisition time significantly shorter (0.9 ± 0.1 s vs 4.0 ± 0 .3 s; p < 0.001) and mean values of CTDIvol and DLP reduced by 46.3% and 47.7%, respectively. Comparing the quality of 70 keV (Group 2) and averaged (Group 1a) images: (a) the mean attenuation within pulmonary arteries did not differ (p = 0.13); (b) the image noise was significantly higher (p < 0.001) in Group 2 with no difference in subjective image noise (p = 0.29); and (c) 89% of examinations were devoid of artifacts in Group 2 vs 28.6% in Group 1a. The percentage of diagnostic examinations was 95.2% (100/105; Group 1a), 100% (53/53; Group 1b), and 95.3% (164/172; Group 2). There were 4.8% (5/105; Group 1a) and 4.7% (8/172; Group 2) of non-diagnostic examinations, mainly due to the suboptimal quality of vascular opacification with the restoration of a diagnostic image quality on low-energy images.

Conclusion

Compared to EID-CT, morphology and perfusion imaging were available in all patients scanned with PCD-CT, with the radiation dose reduced by 48%.

Clinical relevance statement

PCD-CT enables scanning patients with the advantages of both spectral imaging, including high-quality morphologic imaging and lung perfusion for all patients, and fast scanning—a combination that is not simultaneously accessible with EID-CT while reducing the radiation dose by almost 50%.

Key Points

  • The complementarity between morphology and perfusion imaging is accessible in each PCD-CT examination.

  • High-quality images are obtained with PCD-CT in all categories of patients, including dyspneic patients.

  • PCD-CT enables about 50% radiation dose reduction compared with EID-CT.

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Abbreviations

CNR:

Contrast-to-noise ratio

CTA:

CT angiography

CTDIvol :

Volume computed tomography dose index volume

DECT:

Dual energy CT

DLP:

Dose-length-product

EID-CT:

Energy-integrating-detector CT

PCD-CT:

Photon-counting-detector CT

PE:

Acute pulmonary embolism

SNR:

Signal-to-noise ratio

VMI:

Virtual monoenergetic imaging

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Authors and Affiliations

  1. ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France

    Martine Remy-Jardin & Alain Duhamel

  2. IMALLIANCE-Haut-de-France, Valenciennes, France

    Martine Remy-Jardin

  3. Department of Thoracic Imaging, University of Lille, Lille, France

    Martine Remy-Jardin, Idir Oufriche, Lucas Guiffault & Jacques Remy

  4. Department of Biostatistics, University of Lille, CHU Lille, Lille, France

    Alain Duhamel

  5. Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany

    Thomas Flohr & Bernhard Schmidt

  6. Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France

    Jacques Remy

Authors
  1. Martine Remy-Jardin
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  2. Idir Oufriche
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Correspondence to Martine Remy-Jardin.

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Guarantor

The scientific guarantor of this publication is Martine Remy-Jardin.

Conflict of interest

Two authors of this manuscript declare relationships with Siemens Healthineers (Forchheim Germany): Jacques REMY: consultant for Siemens Healthineers. Thomas Flohr: Head of the Department of Computed Tomography Research & Development, Siemens Healthineers. The remaining 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

Pr Alain Duhamel, Professor Emeritus and former Head of Biostatistical Department of CHU of Lille, co-author of this study, had the necessary statistical expertise and provided statistical analyses of this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was waived for this retrospective, non-interventional study.

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  • Retrospective

  • Observational

  • Performed at one institution

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Remy-Jardin, M., Oufriche, I., Guiffault, L. et al. Diagnosis of acute pulmonary embolism: when photon-counting-detector CT replaces energy-integrating-detector CT in daily routine. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10724-5

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