Airway quantifications of bronchitis patients with photon-counting and energy-integrating computed tomography.

PURPOSE: Accurate airway measurement is critical for bronchitis quantification with computed tomography (CT), yet optimal protocols and the added value of photon-counting CT (PCCT) over energy-integrating CT (EICT) for reducing bias remain unclear. We quantified biomarker accuracy across modalities and protocols and assessed strategies to reduce bias. APPROACH: A virtual imaging trial with 20 bronchitis anthropomorphic models was scanned using a validated simulator for two systems (EICT: SOMATOM Flash; PCCT: NAEOTOM Alpha) at 6.3 and 12.6 mGy. Reconstructions varied algorithm, kernel sharpness, slice thickness, and pixel size. Pi10 (square-root wall thickness at 10-mm perimeter) and WA% (wall-area percentage) were compared against ground-truth airway dimensions obtained from the 0.1-mm-precision anatomical models prior to CT simulation. External validation used clinical PCCT ( n = 22 ) and EICT ( n = 80 ). RESULTS: Simulated airway dimensions agreed with pathological references ( R = 0.89 - 0.93 ). PCCT had lower errors than EICT across segmented generations ( p < 0.05 ). Under optimal parameters, PCCT improved Pi10 and WA% accuracy by 26.3% and 64.9%. Across the tested PCCT and EICT imaging protocols, improvements were associated with sharper kernels (25.8% Pi10, 33.0% WA%), thinner slices (23.9% Pi10, 49.8% WA%), smaller pixels (17.0% Pi10, 23.1% WA%), and higher dose ( ≤ 3.9 % ). Clinically, PCCT achieved higher maximum airway generation ( 8.8 ± 0.5 versus 6.0 ± 1.1 ) and lower variability, mirroring trends in virtual results. CONCLUSIONS: PCCT improves the accuracy and consistency of airway biomarker quantification relative to EICT, particularly with optimized protocols. The validated virtual platform enables modality-bias assessment and protocol optimization for accurate, reproducible bronchitis measurements.

Duke Scholars

Author Ehsan Abadi Radiology

Author Ehsan Samei Radiology