Photon-Counting Detector CT for Femoral Stent Imaging in an Extracorporeally Perfused Human Cadaveric Model

Background and Aims: This study aims to compare the performance of first-generation dual-source photon-counting detector computed tomography (PCD-CT) to third-generation dual-source energy-integrating detector (EID-CT) regarding stent imaging in the femoral arterial runoff. Methods: Continuous extracorporeal perfusion was established in 1 human cadaver using an inguinal and infragenicular access and peristaltic pump. Seven peripheral stents were implanted into both superior femoral arteries by means of percutaneous angioplasty. Radiation dose-equivalent CT angiographies (high-/medium-/low-dose: 10/5/3 mGy) with constant tube voltage of 120 kVp, matching iterative reconstruction algorithm levels, and convolution kernels were used both with PCD-CT and EID-CT. In-stent lumen visibility, luminal and in-stent attenuation as well as contrast-to-noise ratio (CNR) were assessed via region of interest and diameter measurements. Results were compared using analyses of variance and regression analyses. Results: Maximum in-stent lumen visibility achieved with PCD-CT was 94.48% +/- 2.62%. The PCD-CT protocol with the lowest lumen visibility (BV40: 78.93% +/- 4.67%) performed equal to the EID-CT protocol with the best lumen visibility (BV59: 79.49% +/- 2.64%, P > 0.999). Photon-counting detector CT yielded superior CNR compared with EID-CT regardless of kernel and dose level (P < 0.001). Maximum CNR was 48.8 +/- 17.4 in PCD-CT versus 31.28 +/- 5.7 in EID-CT (both BV40, high-dose). The theoretical dose reduction potential of PCD-CT over EID-CT was established at 88% (BV40), 83% (BV48/49), and 73% (BV59/60), respectively. In-stent attenuation was not significantly different from luminal attenuation outside stents in any protocol. Conclusions: With superior lumen visibility and CNR, PCD-CT allowed for noticeable dose reduction over EID-CT while maintaining image quality in a continuously perfused human cadaveric model.