Detectability of Iodine in Mediastinal Lesions on Photon Counting CT: A Phantom Study

<b>Background/Objectives:</b> To evaluate the detectability of iodine in mediastinal lesions with photon counting CT (PCCT) compared to conventional CT (CCT) in a phantom study. <b>Methods:</b> Mediastinal lesions were simulated by five cylindrical inserts with diameters from 1 to 12 mm within a 10 cm solid water phantom that was placed in the mediastinal area of an anthropomorphic chest phantom with fat ring (QRM-thorax, QRM L-ring, 30 cm × 40 cm cross-section). Inserts were filled with iodine contrast at concentrations of 0.238 to 27.5 mg/mL. A clinical chest protocol at 120 kV on a high-end CCT (Somatom Force, Siemens Healthineers) was compared to the same protocol on a PCCT (Naeotom Alpha, Siemens Healthineers). Images reconstructed with a soft tissue kernel at 1 mm thickness and a 512 matrix served as a reference. For PCCT, we studied the result of reconstructing virtual mono-energetic images (VMIs) at 40, 50, 60 and 70 keV, reducing exposure dose up by 66%, reducing slice thickness to 0.4 and 0.2 mm, and increasing matrix size from 512 to 768 and 1024. Two observers with similar experience independently determined the smallest insert size for which iodine enhancement could still be detected. Consensus was reached when detectability thresholds differed between observers. <b>Results:</b> CTDIvol on PCCT and CCT was 3.80 ± 0.12 and 3.60 ± 0.01 mGy, respectively. PCCT was substantially more sensitive than CCT for detection of iodine in small mediastinal lesions: to detect a 3 mm lesion, 11.2 mg/mL iodine was needed with CCT, while only 1.43 mg/mL was required at 40 keV and 50 keV with PCCT. Moreover, dose reduced by 66% resulted in a comparable detection of iodine between PCCT and CCT for all lesions, except 3 mm. Detection increased from 11.2 mg/mL on CCT to 4.54 mg/mL on PCCT. A matrix size of 1024 reduced this detection threshold further, to 0.238 mg/mL at 40 and 50 keV. For 5 mm lesions, this detection threshold of 0.238 mg/mL was already achieved with a 512 matrix. Very small, 1 mm lesions did not profit from PCCT except if reconstructed with a 1024 matrix, which reduced the detection threshold from 27.5 mg/mL to 11.2 mg/mL. Reduced slice thickness decreased iodine detection of 3-12 mm lesions but not for 1 mm lesions. <b>Conclusions:</b> Iodine detectability with PCCT is at least equal to CCT for simulated mediastinal lesions of 1-12 mm, even at a dose reduction of 66%. Iodine detectability further profits from virtual monoenergetic images of 40 and 50 keV and increased reconstruction matrix.