Ultrahigh-resolution computed tomography of the cervical spine without dose penalty employing a cadmium-telluride photon-counting detector

This cadaveric study compared image quality between a third-generation dual-source CT scanner with energy-integrating detector technology (EID) and a first-generation CT system employing a photon-counting detector (PCD) for the cervical spine in ultrahigh-resolution mode.The cervical spine of eight formalin-fixed full-body cadaveric specimens was scanned with both CT systems using 140 kVp scan protocols matched for CTDIvol (full-dose; low-dose; ultralow-dose; 10 mGy; 3 mGy; 1 mGy). Images were reconstructed with 1 mm slice thickness and 0.5 mm increment. Three radiologists rated overall subjective image quality based on an equidistant five-point scale with the intraclass correlation coefficient (ICC) calculated for assessment of interobserver reliability. Contrast-to-noise ratios were calculated individually for bone (CNRbone) and muscle tissue (CNRmuscle) to provide objective criteria of image analysis.Subjective image quality, as well as CNRbone, and CNRmuscle were each superior for PCD-CT compared to EID-CT among dose-matched scan protocol pairs (all p < 0.05). Between full-dose EID-CT and low-dose PCD-CT, subjective image quality was equal (p = 0.903), while superior quantitative results regarding the latter were ascertained (both p < 0.001). Similarly, objective analysis determined higher CNRbone, and CNRmuscle in ultralow-dose PCD-CT compared to low-dose EID-CT (both p < 0.001), while readers considered the image quality of the respective studies comparable (p > 0.99). Interobserver reliability was good, denoted by an ICC of 0.861 (95 % confidence interval: 0.788 - 0.914; p < 0.001).In cervical spine examinations, both subjective and objective image quality of PCD-CT were superior to EID-CT in comparison of scan protocols with corresponding dose levels, suggesting potential for significantly reducing the radiation exposure without compromising image quality.