Radiation dose and image quality of photon-counting detector CT for multiphasic pre-transplant abdominal imaging in young children aged ≤36 months: a propensity-matched study
Xiang-Yu Liu, Wei-Dong Qiao, Ruo-Yang Shi, Wei-Hui Xie, Tang-Xu Sun, Sheng-Yang Xu, Xiao Lu, Ji Wang, Lian-Ming WuAbstract
Objectives
To compare radiation dose and image quality between photon-counting detector CT (PCCT) and conventional energy-integrating detector CT (EID-CT) in multiphasic contrast-enhanced abdominal imaging of infants and toddlers, and to evaluate the phase-dependent performance of two monoenergetic reconstructions.
Methods
In this single-center study, prospective PCCT examinations were compared with retrospective EID-CT examinations. After propensity score matching for age, body mass index, and water-equivalent diameter, 54 matched pairs were analyzed. Radiation dose, objective image quality, and blinded subjective image quality were assessed across arterial, portal venous, and delayed phases.
Results
PCCT achieved substantially lower radiation exposure than EID-CT, with reductions of approximately 70%–75% in CTDIvol, DLP, and SSDE (all P < .001). The 50-keV reconstruction consistently produced the highest attenuation values, whereas 70-keV images showed the lowest noise and the most stable SNR across phases. Differences in CNR were limited and region dependent. Subjective image quality remained diagnostically acceptable for all protocols, with PCCT demonstrating comparable or superior score distributions relative to EID-CT, particularly in the portal venous phase.
Conclusions
PCCT enables substantial radiation dose reduction while maintaining diagnostic image quality in multiphasic pediatric abdominal CT. The complementary characteristics of 50- and 70-keV reconstructions support a phase-adapted reconstruction strategy for protocol optimization in infants.
Advances in knowledge
Photon-counting CT reduced radiation dose by approximately 70%–75% in multiphasic abdominal CT in infants and toddlers while maintaining diagnostic image quality. Low- and intermediate-energy monoenergetic reconstructions showed complementary phase-dependent performance, supporting phase-adapted protocol optimization.