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Objectives Photon-counting detector CT (PCD-CT) promises a leap in spatial resolution due to smaller detector pixel sizes than implemented in energy-integrating detector CTs (EID-CT). Our objective was to compare the visualization of smallest bone details between PCD-CT and EID-CT using a mouse as a specimen. Materials and methods Two euthanized mice were scanned at a 20-slice EID-CT and a dual-source PCD-CT in single-pixel mode at various CTDI Vol  values. Image noise and signal-to-noise ratio (SNR) were evaluated using repeated ROI measurements. Edge sharpness of bones was compared by the maximal slope within CT value plots along sampling lines intersecting predefined bones of the spine. Two readers evaluated bone detail visualization at four regions of the spine on a three-point Likert scale at various CTDI Vol ’s. Two radiologists selected the series with better detail visualization among each of 20 SNR-matched pairs of EID-CT and PCD-CT series. Results In CTDI Vol -matched scans, PCD-CT series showed significantly lower image noise (Noise  CTDI = 5 mGy  : 16.27 ± 1.39 vs. 23.46 ± 0.96 HU,  p  &lt; 0.01), higher SNR (SNR  CTDI = 5 mGy  : 20.57 ± 1.89 vs. 14.00 ± 0.66,  p  &lt; 0.01), and higher edge sharpness (Edge Slope lumbar spine : 981 ± 160 vs. 608 ± 146 HU/mm,  p  &lt; 0.01) than EID-CT series. Two radiologists considered the delineation of bone details as feasible at consistently lower CTDI Vol  values at PCD-CT than at EID-CT. In comparison of SNR-matched reconstructions, PCD-CT series were still considered superior in almost all cases. Conclusions In this head-to-head comparison, PCD-CT showed superior objective and subjective image quality characteristics over EID-CT for the delineation of tiniest bone details. Even in SNR-matched pairs (acquired at different CTDI Vol ’s), PCD-CT was strongly preferred by radiologists. Key Points •  In dose-matched scans, photon-counting detector CT series showed significantly less image noise, higher signal-to-noise ratio, and higher edge sharpness than energy-integrating detector CT series . •  Human observers considered the delineation of tiny bone details as feasible at much lower dose levels in photon-counting detector CT than in energy-integrating detector CT . •  In direct comparison of series matched for signal-to-noise ratio, photon-counting detector CT series were considered superior in almost all cases .

Visualization of bone details in a novel photon-counting dual-source CT scanner—comparison with energy-integrating CT