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Mixed coronary plaque characterization with the first clinical dual-source photon-counting CT scanner: a phantom study

Purpose: to investigate image quality of the ultra-high-resolution (UHR) mode of a dual-source photon-counting CT scanner in visualizing mixed (soft and hard) coronary artery plaques. Materials and methods: We scanned a custom-made phantom with 10 mixed plaques of various sizes and compositions. Each scan was repeated three times. Images were reconstructed with FBP, and model-based quantum iterative reconstruction (QIR). Image quality was investigated by measuring mean CT numbers, noise standard deviation (SD), and by line profiles. Results: UHR mode provided sharper difference between soft and hard plaques, and the lumen by reducing blooming artifacts. Furthermore, it improved the true CT number of the values by reducing partial volume However, SD of noise increases by a factor of ~8 in FBP reconstructions at thinnest slice thickness (0.2 mm). Quantum iterative reconstruction algorithm reduced image noise x4 of the SR FBP without any apparent loss of spatial resolution. Conclusion: UHR PCCT improves plaque characterization through improved spatial resolution which results in lower blooming artifacts and partial volume effects. The increase in image noise can be mitigated by using model-based iterative reconstruction algorithms without any loss of spatial resolution. Depending on the imaging task, further noise reduction can be achieved by reconstructing thicker slices. A more detailed investigation with noise power spectrum analysis and observer model studies is warranted.