This exploratory study investigated optimal image reconstruction settings for photon-counting detector CT (PCD-CT) in evaluating hepatocellular carcinoma (HCC). Twenty patients with HCC underwent PCD-CT, and the datasets were retrospectively reconstructed using four abdominal kernels (Br40, Br44, Br48, and Br56) and three slice thicknesses (0.4 mm, 1.0 mm, and 3.0 mm). The standard setting, Br40 at 3.0 mm, served as the reference. Three radiologists independently rated the image quality of liver parenchyma, vasculature, and hypervascular lesions on a five-point Likert scale, while image sharpness and noise were assessed quantitatively.
Br44 1.0 mm and Br48 1.0 mm reconstructions provided better visualization of hepatic vasculature compared with the reference. Br40 1.0 mm and Br44 3.0 mm yielded the highest overall image quality scores. Sharper kernels and thinner slices improved vessel delineation but increased image noise, leading to a reduced contrast-to-noise ratio. However, the overall sharpness values did not differ significantly from the reference protocol.
In conclusion, the Br40 1.0 mm reconstruction provided the best balance between image quality and noise for HCC assessment, while Br44 1.0 mm and Br48 1.0 mm reconstructions were optimal for detailed evaluation of the hepatic vasculature.