Characterization of Urinary Stone Composition by Use of Whole-body, Photon-counting Detector CT

Rational and Objectives: This study aims to investigate the performance of a whole-body, photon-counting detector (PCD) computed tomography (CT) system in differentiating urinary stone composition. Materials and Methods: Eighty-seven human urinary stones with pure mineral composition were placed in four anthropomorphic water phantoms (35-50 cm lateral dimension) and scanned on a PCD-CT system at 100, 120, and 140 kV. For each phantom size, tube current was selected to match CTDI_vol (volume CT dose index) to our clinical practice. Energy thresholds at [25, 65], [25, 70], and [25, 75] keV for 100, 120, and 140 kV, respectively, were used to generate dual-energy images. Each stone was automatically segmented using in-house software; CT number ratios were calculated and used to differentiate stone types in a receiver operating characteristic (ROC) analysis. A comparison with second- and third-generation dual-source, dual-energy CT scanners with conventional energy integrating detectors (EIDs) was performed under matching conditions. Results: For all investigated settings and smaller phantoms, perfect separation between uric acid and non-uric acid stones was achieved (area under the ROC curve [AUC] = 1). For smaller phantoms, performance in differentiation of calcium oxalate and apatite stones was also similar between the three scanners: for the 35-cm phantom size, AUC values of 0.76, 0.79, and 0.80 were recorded for the second- and third-generation EID-CT and for the PCD-CT, respectively. For larger phantoms, PCD-CT and the third-generation EID-CT outperformed the second-generation EID-CT for both differentiation tasks: for a 50-cm phantom size and a uric acid/non-uric acid differentiating task, AUC values of 0.63, 0.95, and 0.99 were recorded for the second- and third-generation EID-CT and for the PCD-CT, respectively. Conclusion: PCD-CT provides comparable performance to state-of-the-art EID-CT in differentiating urinary stone composition.