Image quality of photon-counting detector CT for visualization of maxillofacial anatomy in comparison with energy-integrating detector CT and intraoperative C-arm CBCT.

Background: Accurate diagnostic imaging is crucial for managing facial fractures, which are a common global occurrence. This study aimed to compare the image quality of Photon Counting Detector CT (PCD-CT) with state-of-the-art Energy Integrating Detector CT (EID-CT) and intraoperative C-arm CBCT (CBCT) in visualizing maxillofacial anatomy using a cadaveric sheep head model.

Methods: Three fresh sheep heads were used, with surgical interventions simulating metal implants in two of them. The specimens were imaged using PCD-CT, EID-CT, and CBCT, following which quantitative assessments of signal-to-noise ratio, sharpness, and artifacts were conducted. A visual grading study was performed by six observers, using criteria focusing on the mandible, orbit, and soft tissues. Statistical analyses included Friedman tests for comparing modalities and Kendall's W and Gwet's AC1 for assessing inter- and intrarater agreement.

Results: PCD-CT demonstrated a significantly higher signal-to-noise ratio (p = 0.03) and bone sharpness (p < 0.001) compared to CBCT. In visual grading, PCD-CT outperformed CBCT, but not EID-CT, particularly in delineating mandibular and orbital structures. EID-CT and PCD-CT showed slightly more severe hypodense artifacts (p = 0.01) but were comparable in streak artifact presentation. The interrater and intrarater agreements indicated consistent evaluations across and within observers.

Conclusion: PCD-CT exhibits superior image quality over CBCT in key parameters essential for maxillofacial imaging, while no apparent improvement was shown compared to state-of-the-art EID-CT. PCD-CT offers enhanced visualization of critical anatomical structures, suggesting its potential as a preferred modality in managing maxillofacial trauma. The findings in this study align with limited existing research on PCD-CT, underscoring its promise for advanced diagnostic imaging in maxillofacial applications.