What’s New in Photon Counting CT?

June 03, 2026 · 20 articles · 15 research themes · covering May 27, 2026 – June 03, 2026

Overview

Across this week’s studies, photon-counting CT (PCCT) continues to move from “promising physics” toward practical clinical workflows—especially where conventional CT struggles with spatial resolution, artifacts, or quantitative reliability. Multiple investigations compare PCCT/PCD-CT with energy-integrating CT (EID-CT) and show gains in image quality under challenging conditions (e.g., beam-hardening in urogenital imaging, reduced-dose temporal bone imaging, and quantitative sharpness/dose tradeoffs in multiple myeloma). Quantitative spectral performance also remains a key theme: differences in virtual monoenergetic imaging and iodine mapping across scanner types highlight that “spectral CT” performance depends on reconstruction and detector implementation, not just the label.

Clinically, the dominant application areas are cardiovascular and quantitative biomarker imaging. Several papers focus on coronary and neurovascular stent evaluation (in-stent restenosis), leveraging PCCT’s improved resolution and artifact handling to support more accurate noninvasive follow-up compared with invasive angiography. In parallel, cardiac and liver studies emphasize PCCT’s ability to derive extracellular volume fraction (ECV) and related iodine-based metrics with improved reproducibility—particularly important in patients where standard methods fail (devices/atrial fibrillation) or where early functional decline needs prediction (segmental hepatic fECV for mALBI deterioration). Outside the vascular/liver axis, lung and oncology work show that PCCT can improve quantitative measurements (nodule volumetry in low-dose screening) and extract tumor-relevant iodine biomarkers linked to histopathology.

Finally, the digest reflects a broader “system-level” push: engineering and procedural innovations are being benchmarked against existing CT platforms (e.g., gantry-based CBCT for full-spine coverage; needle-integrated sensing for tracking and ablation monitoring), while post-surgical imaging advances (tin-filtered PCCT with VMI and iterative metal artifact reduction) aim to make implant follow-up more dependable. Together, these results suggest PCCT’s near-term impact will be greatest where it improves both diagnostic confidence and measurement stability—enabling safer dose reduction, fewer invasive procedures, and more actionable quantitative imaging biomarkers.

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Photon-Counting CT vs Energy-Integrating CT (Comparative Performance & Dose)

Reduced beam hardening in urogenital imaging with photon-counting CT: a retrospective direct comparison with conventional CT.

This retrospective direct comparison evaluated whether photon-counting CT (PCCT) improves image quality and reduces beam-hardening artifacts versus energy-integrating CT (EID-CT) in urogenital imaging of the lower pelvis and perirenal area in 35 patients. The key finding was that PCCT reduced beam-hardening artifacts and improved image quality metrics compared with conventional EID-CT, as assessed by four radiologists using both subjective and quantitative measures. Clinically, this could increase diagnostic precision in perirenal and lower-pelvis imaging where conventional CT is limited by artifacts and noise.

Brandt EGS, Müller FC, Nielsen YJ et al. · Acta radiologica (Stockholm, Sweden : 1987) · (2026) · View on PubMed ↗

Comparison of photon-counting CT with energy-integrating CT in temporal bone imaging: an anthropomorphic phantom study.

This anthropomorphic phantom study compared photon-counting CT (PCCT) with energy-integrating CT (EICT) for temporal bone imaging at clinically relevant reduced radiation doses. The key finding was that PCCT maintained or improved image quality and visualization of anatomical landmarks compared with EICT under dose reduction conditions. This is significant because it supports the feasibility of lowering radiation dose in temporal bone CT while preserving diagnostic performance.

Pellby D, Vestin-Fredriksson M, Rönnblom A et al. · Acta radiologica (Stockholm, Sweden : 1987) · (2026) · View on PubMed ↗

Gantry-based cone-beam CT of the thoracolumbar spine: A phantom comparison with Photon-Counting CT and Energy-Integrating CT.

This phantom study evaluated a novel gantry-based, multi-scan cone-beam CT (CBCT) system for thoracolumbar spine imaging with complete anatomic coverage and compared it against dose-matched energy-integrating CT (EI-CT) and photon-counting CT (PCCT) using an anthropomorphic torso phantom. The key finding was the comparative imaging performance of the gantry-based CBCT relative to EI-CT and PCCT under matched protocols, addressing feasibility for full-spine coverage. Scientifically, it supports the development of next-generation CBCT workflows for spine imaging and provides a benchmark against emerging PCCT technology.

Bach U, Cester D, Kroschke J et al. · European journal of radiology · (2026) · 1 citations · View on PubMed ↗ · Free PDF ↗

Photon-counting detector computed tomography (PCD-CT) in multiple myeloma: a systematic review and trial sequential meta-analysis on image quality and radiation dose.

This systematic review and trial sequential meta-analysis compared photon-counting detector CT (PCD-CT) versus energy-integrating detector CT (EID-CT) for image quality (sharpness) and radiation dose in patients with multiple myeloma (MM) bone lesions. Across 41 identified studies, five studies (n=170) were included for quantitative synthesis, evaluating whether PCD-CT improves sharpness and/or reduces CTDIvol compared with EID-CT. The findings are significant for optimizing imaging protocols in MM to balance diagnostic quality and radiation exposure.

Ohannesian VA, Taneja BC, do Amaral E Castro A et al. · Skeletal radiology · (2026) · View on PubMed ↗

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Coronary CT Angiography (CCTA) & Coronary In-Stent Restenosis (ISR)

Assessing coronary in-stent restenosis using ultrahigh-resolution photon-counting detector CT: results from a two-center study.

This two-center retrospective study assessed the diagnostic accuracy of ultrahigh-resolution photon-counting detector CT (UHR PCD-CT) for detecting non-obstructive (<50%) and obstructive (≥50%) coronary in-stent restenosis (ISR) in consecutive patients with coronary stents, using invasive coronary angiography (ICA) as the reference standard. UHR PCD-CT reconstructed at 0.2 mm slice thickness (with 0.4 mm serving as an energy-integrating detector CT-like proxy) showed performance for ISR detection across both obstructive and non-obstructive categories. Clinically, the results suggest that UHR PCD-CT may improve noninvasive ISR assessment and reduce reliance on ICA for post-stent evaluation.

Szilveszter B, Hagar MT, Kulyassa P et al. · European journal of radiology · (2026) · 1 citations · View on PubMed ↗ · Free PDF ↗

Initial clinical evaluation of photon-counting detector computed tomography for coronary artery disease in Taiwan.

This retrospective single-center clinical evaluation compared first-generation photon-counting detector CT (PCD-CT) with third-generation energy-integrating detector CT (EID-CT) for coronary artery disease detection in 205 asymptomatic Taiwanese individuals undergoing health-check CCTA (102 with PCD-CT and 103 with EID-CT). The study found that PCD-CT was safe and effective for CAD detection relative to EID-CT in this screening population. These results support the feasibility of deploying early-generation PCD-CT for coronary assessment in real-world asymptomatic cohorts.

Lu YW, Wang KL, Wang YW et al. · Coronary artery disease · (2026) · View on PubMed ↗

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Musculoskeletal Photon-Counting CT (Fracture/Inflammation/Bone & Arthropathy)

Evaluating osseointegration, bone remodeling and osteolysis after total wrist arthroplasty using photon-counting detector CT.

This study evaluated osseointegration, bone remodeling, and periprosthetic osteolysis after total wrist arthroplasty in 19 patients using photon-counting detector CT (PCD-CT) at day 1, 6 months, and 12 months. The key finding was that osseointegration (bone ingrowth to the implant) increased across most evaluated zones over time, with zone-specific differences including the capitate. Clinically, this supports PCD-CT as a quantitative imaging tool for monitoring implant-bone integration and osteolysis after wrist arthroplasty.

Kämmerling N, Farnebo S, Lind G et al. · Skeletal radiology · (2026) · View on PubMed ↗

Evaluation of the use of segmentation-based and deconvolution-based three-dimensional joint space width analysis of the hand and wrist.

This study compared segmentation-based versus grayscale deconvolution-based three-dimensional joint space width (JSW) analysis methods for CT assessment of the hand and wrist in the context of quantifying radiographic joint damage from arthritis. The key finding was a methodological comparison of JSW distribution outputs across different approaches, addressing whether segmentation-based methods can be used beyond metacarpophalangeal joints and how they perform relative to deconvolution-based methods. Scientifically, this supports more sensitive and unbiased 3D CT morphometry for monitoring arthritis progression than traditional ordinal scoring.

Quintiens J, Waungana TH, Kuczynski MT et al. · JBMR plus · (2026) · View on PubMed ↗ · Free PDF ↗

A review of current applications of photon-counting CT in musculoskeletal imaging.

This review summarized current clinical and research applications of photon-counting CT (PCCT) in musculoskeletal imaging, contrasting photon-counting detectors (direct-conversion, energy-resolved) with conventional energy-integrating CT. The key finding is that PCCT’s ultra-high spatial resolution, spectral imaging capability, and electronic noise reduction can improve detection and characterization of fractures, infections, inflammatory and degenerative arthropathies, and bone marrow disorders without increasing radiation exposure. This synthesis supports broader adoption of PCCT for musculoskeletal diagnostics and guides future comparative clinical studies.

Bousson V, Vallot A, Guétat P et al. · Diagnostic and interventional imaging · (2026) · 2 citations · View on PubMed ↗ · Free PDF ↗

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Oncology with Spectral/Photon-Counting CT (Tumor Characterization)

Photon counting computed tomography in head and neck squamous cell carcinoma: iodine concentration and histopathological features.

This study investigated 84 patients with primary untreated head and neck squamous cell carcinoma (HNSCC) using contrast-enhanced photon-counting CT (PCCT) to quantify normalized iodine concentration (NIC) and relate it to histopathological features. The key finding was an association between NIC (derived from intratumoral iodine concentration maps) and tumor histopathology, including proliferation marker Ki-67 (as part of the reported histopathological analysis). This is significant because PCCT-derived iodine metrics may provide imaging biomarkers that reflect tumor biology and aggressiveness in HNSCC.

Surov A, Diallo-Danebrock R, Sonnemann H et al. · Journal of cancer research and clinical oncology · (2026) · View on PubMed ↗ · Free PDF ↗

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Renal Cell Carcinoma & Renal Mass Imaging with Spectral CT

Spectral CT in renal cell carcinoma: the promising role of dual-energy and photon-counting techniques.

This article reviews how spectral CT—specifically dual-energy and photon-counting techniques—can be applied to renal cell carcinoma (RCC) imaging in clinical renal mass evaluation. It highlights that spectral CT can reduce the number of CT phases needed in renal CT/CT urography protocols while maintaining diagnostic accuracy and lowering radiation dose. This matters because it could improve differentiation of cystic versus solid renal lesions and streamline RCC workups using energy- and material-specific information.

Kekelidze M, García-Figueiras R, Kolmos M et al. · Abdominal radiology (New York) · (2026) · View on PubMed ↗

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Lung Nodule Quantification & Low-Dose Screening

Improvement of Lung Nodule Volumetric Accuracy with Photon-counting Computed Tomography Over Energy-integrating Computed Tomography in Low-dose Screening: A Phantom Study.

This phantom study compared lung nodule volumetric accuracy and precision between photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT) under low-dose lung cancer screening protocols using an anthropomorphic chest phantom with 12 artificial nodules. It found that PCD-CT improved volumetric accuracy versus EID-CT and that reconstruction parameters (e.g., slice thickness, matrix size, kernel, iterative reconstruction, and virtual monoenergetic imaging energy) could be optimized to further improve volumetry. This is significant because it supports more reliable quantitative nodule measurements for low-dose screening, potentially improving longitudinal detection and follow-up.

Hop JF, Greuter MJW, van Dijk M et al. · Investigative radiology · (2026) · View on PubMed ↗

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CT Reconstruction, Spectral Accuracy & Virtual Monoenergetic Imaging (VMI)

Comparison of spectral performance of three dual-energy CT scanners equipped with a deep-learning image reconstruction algorithm and one photon counting CT scanner: A phantom study.

This phantom study compared spectral performance across three dual-energy CT (DECT) scanners using deep-learning reconstruction (rapid kV-switching, ultrafast kV-switching, and dual-layer CT) versus one photon-counting CT (PCCT) scanner. The key finding was how virtual monoenergetic images (VMIs) at low keV levels and iodine maps differed among systems, reflecting differences in spectral accuracy and iodine quantification. This is important for selecting CT platforms for quantitative spectral imaging tasks such as contrast-based lesion characterization.

Greffier J, Salvat C, Pastor M et al. · Diagnostic and interventional imaging · (2026) · 4 citations · View on PubMed ↗ · Free PDF ↗

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Metal Artifact Reduction & Post-Surgical Implant Imaging

Photon-counting CT in Anterior Cervical Discectomy and Fusion: Improved Metal Artifact Reduction and Impact on Bone Fusion Assessment.

This retrospective study evaluated tin-filtered photon-counting CT (PCD-CT) with high-energy virtual monoenergetic imaging (VMI) and iterative metal artifact reduction (iMAR) in patients after anterior cervical discectomy and fusion (ACDF) to improve metal artifact reduction and bone fusion assessment. The key finding was that combining VMI120 with iMAR (VMI120 + iMAR) improved metal artifact reduction and image quality, thereby enhancing assessment of intragraft and extragraft bone fusion. This is clinically important because better post-surgical imaging around metal implants can improve the reliability of fusion evaluation and follow-up decisions.

Abel F, Curti M, Marth T et al. · Investigative radiology · (2026) · View on PubMed ↗ · Free PDF ↗

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Cardiac ECV/Virtual Noncontrast Methods (Devices/AF Challenges)

Virtual Noncontrast Images Derived From Photon-Counting CT Enhance Inter-Reader Reproducibility of Myocardial ECV Measurement in Patients With Cardiac Devices.

This retrospective study assessed whether a single-scan virtual noncontrast (VNC) method using photon-counting CT (PCCT) improves inter-reader reproducibility of left ventricular myocardial extracellular volume fraction (ECV) measurement compared with the standard subtraction method in 59 patients with cardiac devices and/or atrial fibrillation (AF). The key finding was enhanced reproducibility of myocardial ECV measurements with the PCCT VNC approach in these challenging populations where misregistration is common. This supports more reliable ECV quantification for cardiac assessment in patients with prosthetic valves and cardiac implantable electronic devices (CIEDs) or AF.

Yamakami Y, Hirasawa K, Hada H et al. · Journal of computer assisted tomography · (2026) · View on PubMed ↗

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Noninvasive Imaging Patient Experience & Implementation (PROs)

Evaluation of patient-reported outcomes in coronary CT angiography versus invasive coronary angiography.

This study evaluated patient-reported outcomes (PROs) related to acceptance and emotional responses to coronary CT angiography (CCTA) in 151 patients undergoing standardized dual-source CT or photon-counting CT, including 69 with prior invasive coronary angiography (ICA). Patients generally accepted CCTA, with emotional experiences and acceptance measured via PRO instruments and compared between those with and without prior ICA exposure. These findings support the patient-centered implementation of CCTA—particularly photon-counting CT protocols—as a noninvasive alternative to ICA for intermediate pre-test probability or stable coronary artery disease (CAD).

von der Stück MS, Siepmann R, Corban E et al. · European journal of radiology open · (2026) · View on PubMed ↗ · Free PDF ↗

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CT for Liver Function Decline (fECV/mALBI Prediction)

Segmental fECV measurement using PCD-CT as an early predictor of liver function decline in chronic liver disease.

This study investigated whether segmental hepatic extracellular volume fraction (fECV) measured with photon-counting detector CT (PCD-CT) can predict early liver function decline in chronic liver disease (CLD), using modified albumin-bilirubin (mALBI) grade as the reference. In 146 CLD patients undergoing PCD-CT with 3-minute equilibrium phase imaging, segmental fECV derived from iodine densities in the aorta and Couinaud segments (S2–S8) showed diagnostic utility for predicting early mALBI deterioration. Clinically, this suggests PCD-CT–based segmental fECV could serve as an early imaging biomarker for impending liver function decline.

Ohtani T, Shimada M, Takahashi K et al. · Abdominal radiology (New York) · (2026) · View on PubMed ↗ · Free PDF ↗

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Neurovascular Imaging (Stents & ISR)

Ultra-High-Resolution Photon-Counting CT Angiography for Noninvasive Detection of Neurovascular In-Stent Restenosis.

This prospective clinical study assessed ultra-high-resolution photon-counting detector CT angiography (UHR PCD-CTA) for noninvasive detection of neurovascular in-stent restenosis (ISR) in consecutive patients after neurovascular stent implantation. The key finding was that UHR PCD-CTA improved visualization for ISR detection by addressing conventional CTA limitations such as blooming artifacts and insufficient spatial resolution. Scientifically and clinically, this suggests PCD-CTA could enable more accurate, noninvasive ISR assessment compared with standard energy-integrating CTA.

Su CQ, Zhou C, Wu PF et al. · Stroke · (2026) · View on PubMed ↗

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Image-Guided Interventions & Needle Tracking/Ablation Monitoring

Novel Acousto-Optic Sensor for Needle Tip Tracking and Internal Ultrasound Imaging from the Tip for Biopsy and Thermal Ablation.

This bench and ex vivo study evaluated a novel acousto-optic sensor embedded in a 24-gauge needle stylet for real-time 3D needle tip tracking, internal ultrasound imaging, and thermal ablation monitoring under ultrasound guidance in phantom and bovine liver models. The sensor enabled accurate in-plane needle localization relative to the ultrasound imaging plane and detected ablation margins with relative temperature estimation during ablation. These results are significant for improving the safety and effectiveness of image-guided biopsy and thermal ablation by integrating tracking and monitoring directly into the needle.

Saccenti L, Li M, Hazen L et al. · Journal of vascular and interventional radiology : JVIR · (2026) · View on PubMed ↗ · Free PDF ↗

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Spine/Neurodiagnostic Procedures (Non-CT/Procedure Case Reports)

Sacral CSF-venous fistula diagnosed using single-day bilateral decubitus myelography: A rare case and a novel technical modification.

This case report described a rare sacral CSF-venous fistula (right S2) diagnosed using single-day bilateral decubitus myelography with a novel technical modification. The key finding was that the modified myelographic technique enabled detection of the sacral fistula despite the known difficulty of identifying sacral CSF-venous fistulas. Clinically, this provides a practical procedural approach that may improve diagnosis of this uncommon cause of spontaneous intracranial hypotension.

Kodet ML, Madhavan AA · Radiology case reports · (2026) · View on PubMed ↗ · Free PDF ↗

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Generated automatically on June 03, 2026. Covers PubMed articles published May 27, 2026 – June 03, 2026. Summaries are AI-generated; always consult the original publication for clinical or research decisions.