PCCT showed higher interrater agreement than conventional CT for key structural features in capitellar osteochondritis dissecans.
The number of loose bodies and the presence of an osseous bridge demonstrated significantly improved agreement with PCCT compared to conventional CT.
Despite higher spatial resolution, several features such as fragmentation, depth, and tilting remained poorly reproducible, highlighting intrinsic limitations beyond image quality.
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Figure 1. Conventional CT scan (A and C) versus photon-counting CT scan made 2 months later (B and D) of a patient with capitellar osteochondritis dissecans in the right elbow. An illustrative case of a 15-year-old male tennis player, training 5 times a week. For 2 years, he had pain in his lateral right elbow when playing (dominant side), and the pain was progressive for 3-4 months. The pain had an insidious onset without any causal moment, and there were no locking complaints. A conventional CT scan (A, coronal plane; C, sagittal plane) was made at a secondary referral hospital showing capitellar osteochondritis in the elbow joint. Two months later, the scan was repeated using photon-counting technology (B, coronal plane; D, sagittal plane) after referral to Erasmus MC, showing slightly increased fragmentation and increased dislocation of the fragments. Also, a loose body was detected (scan D, green arrow) in the radiocapitellar joint. This loose body was located in the ulnohumeral joint in scan C (not visible in this frame). Based on these scans, the patient went directly for arthroscopy, showing an unstable osteochondritis dissecans lesion. It was no longer possible to fixate fragments within their origin, so débridement and microfracturing were performed, as well as removal of the loose body. CT, computed tomography.
Source: Steenbeek et al., JSES International, 2026.
Protocol
Detail | Value |
|---|
Scanner | NAEOTOM Alpha |
Software | n.a. |
Scan area | Elbow (capitellum) |
Scan mode | Quantum HD |
Scan direction | n.a. |
Tube voltage [kV] | 120 |
CTDIvol [mGy] | 4.5 – 6.5 |
Slice collimation [mm] | 120 × 0.2 |
Slice width [mm] | 0.2 |
Reconstruction increment [mm] | 0.1 |
Reconstruction kernel | Br89 |
Steenbeek ED et al. Interrater agreement for characterization of capitellar osteochondritis dissecans using photon-counting computed tomography technology. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101676-
