肝细胞癌（HCC）是唯一一种可以基于影像进行无创诊断而不需要进一步的组织学证据的肿瘤实体。因此，对于HCC的诊断来说，优秀的图像质量至关重要。新型光子计数探测器（PCD）CT通过噪声降低和更高的空间分辨率改善了图像质量，天然地提供了光谱信息。本研究的目的是通过三期肝脏PCD-CT的幻影和患者人口研究，重点研究识别最佳重建核的HCC成像中的这些改进。执行幻影实验以分析常规体和定量重建核每个具有四个锐度等级（36-40-44-48）的客观质量特征。用PCD-CT在24名具有存活性HCC病灶的患者中，使用这些核心再构建50 keV的虚拟单能量图像。定量图像分析包括对比度噪声比（CNR）和边缘锐度。三名评估员进行定性分析，评估噪声、对比度、病灶显著性和整体图像质量。在所有对比度相位中，CNR在使用锐度水平36的核心时最高（全部p <0.05），对病灶锐度没有显著影响。也评价更柔和重建核对于噪声和图像质量更好（全部p <0.05）。在图像对比度和病灶显著性方面没有显着差异。将具有相同锐度级别的体和定量核心进行比较，无论是在体外还是体内分析中，图像质量标准都没有差异。在PCD-CT的评估HCC的情况下，软重建核产生最佳总体质量。由于具有潜在原始光谱处理能力的定量核与常规体核相比在图像质量上并不受限制，因此应优先选择它们。

Hepatocellular carcinoma (HCC) is the only tumor entity that allows non-invasive diagnosis based on imaging without further histological proof. Therefore, excellent image quality is of utmost importance for HCC diagnosis. Novel photon-counting detector (PCD) CT improves image quality via noise reduction and higher spatial resolution, inherently providing spectral information. The aim of this study was to investigate these improvements for HCC imaging with triple-phase liver PCD-CT in a phantom and patient population study focusing on identification of the optimal reconstruction kernel.Phantom experiments were performed to analyze objective quality characteristics of the regular body and quantitative reconstruction kernels, each with four sharpness levels (36-40-44-48). For 24 patients with viable HCC lesions on PCD-CT, virtual monoenergetic images at 50 keV were reconstructed using these kernels. Quantitative image analysis included contrast-to-noise ratio (CNR) and edge sharpness. Three raters performed qualitative analyses evaluating noise, contrast, lesion conspicuity, and overall image quality.In all contrast phases, the CNR was highest using the kernels with a sharpness level of 36 (all p < 0.05), with no significant influence on lesion sharpness. Softer reconstruction kernels were also rated better regarding noise and image quality (all p < 0.05). No significant differences were found in image contrast and lesion conspicuity. Comparing body and quantitative kernels with equal sharpness levels, there was no difference in image quality criteria, neither regarding in vitro nor in vivo analysis.Soft reconstruction kernels yield the best overall quality for the evaluation of HCC in PCD-CT. As the image quality of quantitative kernels with potential for spectral post-processing is not restricted compared to regular body kernels, they should be preferred.Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.