Improved visualization of temporal bone structures with photon-counting detector CT : An intra-patient comparison

OBJECTIVE: To directly compare the image quality of photon-counting detector CT (PCD-CT) and conventional energy-integrating detector CT (EID-CT) for temporal bone imaging within the same patient cohort. METHODS: This retrospective study included seven patients who underwent both EID-CT and PCD-CT for clinical indications. To ensure a valid comparison of the imaging technologies, images of the non-operated, contralateral temporal bone were evaluated. Radiation dose parameters, including volume CT dose index (CTDIvol) and dose-length product (DLP), were recorded. Two board-certified otolaryngologists independently rated the visualization of six key anatomical structures (incudostapedial joint, incudomalleolar joint, oval window, round window, modiolus, and scutum) using a 5-point Likert scale. RESULTS: PCD-CT demonstrated significantly superior visualization for all six evaluated structures according to both readers (p < 0.05 for all). The average Likert scores for PCD-CT compared to EID-CT ranged from 3.7 to 5.0, indicating that image quality was consistently rated as "mildly superior" to "substantially superior." There was no significant difference in radiation dose (CTDIvol and DLP) between the two protocols. CONCLUSION: In a direct intra-patient comparison, PCD-CT provides superior image quality and visualization of fine anatomical structures of the temporal bone at a radiation dose comparable to conventional EID-CT. This technology represents a significant advancement for otologic imaging.