Potential of photon counting computed tomography derived spectral reconstructions to reduce beam-hardening artifacts in chest CT

Purpose: Aim of the recent study is to point out a method to optimize quality of CT scans in oncological patients with port systems. This study investigates the potential of photon counting computed tomography (PCCT) for reduction of beam hardening artifacts caused by port-implants in chest imaging by means of spectral reconstructions. Method: In this retrospective single-center study, 8 ROIs for 19 spectral reconstructions (polyenergetic imaging, monoenergetic reconstructions from 40 to 190 keV as well as iodine maps and virtual non contrast (VNC)) of 49 patients with pectoral port systems undergoing PCCT of the chest for staging of oncologic disease were measured. Mean values and standard deviation (SD) Hounsfield unit measurements of port-chamber associated hypo- and hyperdense artifacts, bilateral muscles and vessels has been carried out. Also, a structured assessment of artifacts and imaging findings was performed by two radiologists. Results: A significant association of keV with iodine contrast as well as artifact intensity was noted (all p < 0.001). In qualitative assessment, utilization of 120 keV monoenergetic reconstructions could reduce severe and pronounced artifacts completely, as compared to lower keV reconstructions (p < 0.001). Regarding imaging findings, no significant difference between monoenergetic reconstructions was noted (all p > 0.05). In cases with very high iodine concentrations in the subclavian vein, image distortions were noted at 40 keV images (p < 0.01). Conclusions: The present study demonstrates that PCCT derived spectral reconstructions can be used in oncological imaging of the thorax to reduce port-derived beam-hardening artefacts. When evaluating image data sets within a staging, it can be particularly helpful to consider the 120 keV VMIs, in which the artefacts are comparatively low.