Role of photon-counting computed tomography in pediatric cardiovascular imaging

Abstract

Photon-counting computed tomography (PCCT) represents a significant advancement in pediatric cardiovascular imaging. Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light, whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals. This direct conversion allows photon-counting detectors to sort photons into discrete energy levels, thereby enhancing image quality through superior noise reduction, improved spatial and contrast resolution, and reduced artifacts. In pediatric applications, PCCT offers substantial benefits, including lower radiation doses, which may help reduce the risk of malignancy in pediatric patients, with perhaps greater potential to benefit those with repeated exposure from a young age. Enhanced spatial resolution facilitates better visualization of small structures, vital for diagnosing congenital heart defects. Additionally, PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images, which enhance soft-tissue contrast and potentially reduce contrast media doses. Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conventional CT, particularly in challenging pediatric cardiovascular cases. As PCCT technology matures, further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices, ensuring optimized diagnostic outcomes and patient safety.

Keywords: Cardiovascular; Photon-counting detectors; Pediatric; Photon-counting computed tomography; Computed tomography

Core Tip: Photon-counting computed tomography (PCCT) offers significant advancements in pediatric cardiovascular imaging, enhancing image quality, reducing noise and artifacts, and lowering radiation doses. This article highlights its potential to improve diagnostic accuracy and patient safety in pediatric care. PCCT reduces noise by 58%-89% compared to traditional CT systems at the same radiation doses, enhancing image clarity and diagnostic accuracy. PCCT achieves a maximum in-plane resolution of 0.11 mm, significantly better than conventional CT, which is essential for detailed imaging of small anatomical structures. PCCT provides high-quality imaging at lower radiation doses, helpful for minimizing long-term cancer risks in pediatric patients with repeated exposure to radiation.