Photon-Counting CT Beats Dual-Source CT at Detecting Heart Defects in Babies

In the neonatal stage, congenital heart defects emerge as the leading cause of sickness and death, impacting nearly one percent of all live births. Around a quarter of these defects are severe, necessitating surgical treatments within the first month post-birth. In order to plan for the operation and devise virtual and printed 3D heart models, extensive evaluation using ultrasound, MRI, and CT scans is usually required. Now, a study has found that a new advanced form of CT imaging called photon-counting computed tomography (PCCT) offers superior cardiovascular imaging quality at a comparable radiation dose to dual-source CT (DSCT) for infants with suspected cardiac defects.

PCCT is an emerging imaging technique that records the exact count and energy measurements of incoming X-ray photons. In comparison to DSCT, PCCT delivers higher image resolution and/or lower radiation doses, a feature that is especially useful in pediatric imaging. Although the efficacy of PCCT in enhancing cardiovascular CT imaging in adults has been established, there is a dearth of information about its application in neonates and young children. For their study, researchers at RWTH Aachen University Hospital (Aachen, Germany) assessed pre-existing clinical CT scans of 113 children who had undergone contrast-enhanced PCCT (30 infants), DSCT (83 infants), or both (one infant) for their heart and thoracic aorta from January 2019 through October 2022. The group under study was comprised of 55 girls and 58 boys, with a median age of 66 days.

The researchers found that the PCCT images were sharper, had less image noise, and demonstrated higher contrast than DSCT images. The mean overall visual quality of the images was higher for PCCT than DSCT, using a similar radiation dose. Over 97% of PCCT images met the diagnostic quality criteria, as opposed to 77% of DSCT images. It was also observed by the research team that almost one-fourth of the DSCT images were of restricted or non-diagnostic quality, and 40% were of moderate quality.

“In our study, none of the PCCT examinations exhibited a poor image quality, and only a few were of limited or moderate quality,” said Timm Dirrichs, M.D., senior physician and specialist in cardiothoracic radiology in the Department of Diagnostic and Interventional Radiology at RWTH Aachen University Hospital. “PCCT is a promising method that may improve diagnostic image quality and efficiency compared to DSCT imaging. This higher efficiency can be used to reduce the radiation dose at a given image quality level or to improve image quality at a given radiation level.”

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