Cone-beam versus photon-counting detector CT: Influence of dose variations on the detection of simulated mandibular osseous lesions
Adib Al‐Haj Husain, Victor Mergen, Silvio Valdec, Sebastian Winklhofer, Hatem Alkadhi, Harald Essig, Thomas Frauenfelder, Peter Keßler, Suen An Nynke Lie, Bernd Stadlinger
Abstract
This study compared cone-beam computed tomography (CBCT) and photon-counting detector computed tomography (PCD-CT) for detecting simulated mandibular osseous lesions, emphasizing lesion detectability, quantitative accuracy, and inter-reader reliability at equivalent radiation doses. Three types of simulated osseous lesions (sequestrum/fracture, cystic lesion, and extended periodontal gap) were evaluated by two readers, across three radiation dose levels: high (360 μSv), standard (122 μSv), and low (20 μSv). Image quality, artifact presence, and lesion detectability were qualitatively evaluated using a 5-point Likert scale (5 = highest to 1 = lowest rating). Lesion dimensions were quantitatively measured. Statistical analysis included descriptive statistics and weighted kappa for interobserver reliability. High-dose PCD-CT consistently provided the highest image quality, lesion detectability, and minimal artifacts across all lesion types (5 ± 0), achieving perfect inter-reader agreement (100 %). PCD-CT outperformed CBCT in lesion detectability, with the greatest difference at lower doses (3.87 ± 0.35 to 4.83 ± 0.39 vs. 3.13 ± 0.53 to 4.5 ± 0.52). PCD-CT demonstrated superior inter-reader reliability, with perfect agreement for high-dose (κ = 1.0; p < 0.001) and good agreement for standard- and low-dose protocols (κ = 0.909 and κ = 0.744; p < 0.001). Quantitative measurements showed minimal intermodal differences ranging from 0.15 to 0.34 mm, confirming PCD-CT's clinical precision even at low-dose protocols. These findings highlight PCD-CT's potential in dentomaxillofacial imaging, enhancing diagnostic capabilities and reducing radiation exposure.