Contrast-enhanced spectral mammography with a photon-counting detector.

Purpose: Spectral imaging is a method in medical x-ray imaging to extract information about the object constituents by the material-specific energy dependence of x-ray attenuation. The authors have investigated a photon-counting spectral imaging system with two energy bins for contrast-enhanced mammography. System optimization and the potential benefit compared to conventional non-energy-resolved absorption imaging was studied. Methods: A framework for system characterization was set up that included quantum and anatomical noise and a theoretical model of the system was benchmarked to phantom measurements. Results: Optimal combination of the energy-resolved images corresponded approximately to minimization of the anatomical noise, which is commonly referred to as energy subtraction. In that case, an ideal-observer detectability index could be improved close to 50% compared to absorption imaging in the phantom study. Optimization with respect to the signal-to-quantum-noise ratio, commonly referred to as energy weighting, yielded only a minute improvement. In a simulation of a clinically more realistic case, spectral imaging was predicted to perform approximately 30% better than absorption imaging for an average glandularity breast with an average level of anatomical noise. For dense breast tissue and a high level of anatomical noise, however, a rise in detectability by a factor of 6 was predicted. Another ~70-90% improvement was found to be within reach for an optimized system. Conclusions: Contrast-enhanced spectral mammography is feasible and beneficial with the current system, and there is room for additional improvements. Inclusion of anatomical noise is essential for optimizing spectral imaging systems.