Photon-counting Detector CT with Deep Learning Noise Reduction to Detect Multiple Myeloma

Background: Photon-counting detector (PCD) CT and deep learning noise reduction may improve spatial resolution at lower radiation doses compared with energy-integrating detector (EID) CT. Purpose: To demonstrate the diagnostic impact of improved spatial resolution in whole-body low-dose CT scans for viewing multiple myeloma by using PCD CT with deep learning denoising compared with conventional EID CT. Materials and Methods: Between April and July 2021, adult participants who underwent a whole-body EID CT scan were prospectively enrolled and scanned with a PCD CT system in ultra-high-resolution mode at matched radiation dose (8 mSv for an average adult) at an academic medical center. EID CT and PCD CT images were reconstructed with Br44 and Br64 kernels at 2-mm section thickness. PCD CT images were also reconstructed with Br44 and Br76 kernels at 0.6-mm section thickness. The thinner PCD CT images were denoised by using a convolutional neural network. Image quality was objectively quantified in two phantoms and a randomly selected subset of participants (10 participants; median age, 63.5 years; five men). Two radiologists scored PCD CT images relative to EID CT by using a five-point Likert scale to detect findings reflecting multiple myeloma. The scoring for the matched reconstruction series was blinded to scanner type. Reader-averaged scores were tested with the null hypothesis of equivalent visualization between EID and PCD. Results: Twenty-seven participants (median age, 68 years; IQR, 61–72 years; 16 men) were included. The blinded assessment of 2-mm images demonstrated improvement in viewing lytic lesions, intramedullary lesions, fatty metamorphosis, and pathologic fractures for PCD CT versus EID CT (P <.05 for all comparisons). The 0.6-mm PCD CT images with convolutional neural network denoising also demonstrated improvement in viewing all four pathologic abnormalities and detected one or more lytic lesions in 21 of 27 participants compared with the 2-mm EID CT images (P <.001). Conclusion: Ultra-high-resolution photon-counting detector CT improved the visibility of multiple myeloma lesions relative to energy-integrating detector CT.