What’s New in Photon Counting CT?

June 04, 2026 · 23 articles · 15 research themes · covering May 28, 2026 – June 04, 2026

Overview

This week’s PubMed set highlights how photon-counting CT (PCCT) is moving from “physics promise” to practical clinical value across multiple body systems. Several studies directly compare PCCT with conventional energy-integrating CT (EID-CT), consistently finding improved image quality and/or artifact suppression at equal or reduced dose—seen in abdominal imaging, lower-pelvis/perirenal urogenital scans, and temporal bone imaging. Reviews and phantom work reinforce the underlying mechanisms (e.g., electronic noise rejection and optimized photon-energy weighting), positioning PCCT as a dose-efficient next step for routine CT.

A second dominant theme is spectral imaging and quantitative biomarkers enabled by PCCT’s material discrimination. Phantom and clinical work using virtual monoenergetic images and iodine mapping show differences between detector technologies and reconstruction strategies, while clinical studies extend this quantification into biology: segmental hepatic extracellular volume fraction (fECV) as an early predictor of liver function decline in chronic liver disease, and normalized iodine concentration in head and neck squamous cell carcinoma linked to tumor biology (stage/grade/Ki-67). Related spectral CT review efforts also focus on protocol streamlining for renal cell carcinoma, aiming to reduce phases (and radiation) without losing diagnostic accuracy.

Finally, the collection underscores PCCT’s high spatial resolution and workflow adaptability for vascular and musculoskeletal applications. In neurovascular/spine contexts, streamlined PCCT myelography and high-resolution PCCT angiography approaches target challenging anatomy (CSF–venous fistulas, artery of Adamkiewicz) and aim to reduce limitations like spatial resolution and blooming. In cardiology, ultrahigh-resolution PCCT is evaluated for coronary in-stent restenosis detection, while another study addresses patient-reported outcomes and acceptance for coronary CTA versus invasive angiography. In musculoskeletal care, PCCT is explored for postoperative hardware assessment (metal artifact reduction and fusion evaluation) and implant integration/osteolysis monitoring, alongside broader reviews of PCCT’s role in musculoskeletal diagnosis and quantitative arthritis metrics.

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Photon-Counting CT (PCCT) vs Energy-Integrating CT (EID-CT): Dose & Image Quality

CT Radiation Dose Reduction With Preserved Diagnostic Performance: How Far Have We Come Over 25 Years?

This AJR review summarized 25 years of CT radiation dose reduction strategies and highlighted how photon-counting detector CT further improves dose efficiency. It attributes additional gains to electronic noise rejection, optimal photon-energy weighting, and high-resolution data acquisition. The review is significant because it frames photon-counting CT as a next step in reducing patient radiation exposure while preserving diagnostic performance.

McCollough CH, Yu L · AJR. American journal of roentgenology · (2026) · 2 citations · View on PubMed ↗ · Free PDF ↗

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

This retrospective study compared photon-counting CT (PCCT) with energy-integrating CT (EIDCT) for lower-pelvis and perirenal urogenital imaging in 35 patients scanned on both systems, using subjective and quantitative reader assessments. The key finding was that PCCT reduced beam-hardening artefacts and improved image quality relative to conventional EIDCT in the lower pelvis/perirenal region. Clinically, this could increase diagnostic precision for urogenital CT by mitigating beam-hardening–related loss of image quality.

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) versus energy-integrating CT (EICT) for temporal bone imaging using fresh frozen human temporal bone specimens under clinically relevant reduced radiation dose conditions. The key finding was that PCCT provided comparable or improved image quality and visualization of temporal bone anatomical landmarks relative to EICT at reduced dose. Scientifically and clinically, this supports PCCT as a dose-efficient alternative for temporal bone imaging where fine bony detail is critical.

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

Photon-counting computed tomography enables low-dose, high-quality abdominal imaging: A comparative study with energy-integrating detector computed tomography.

This comparative clinical study evaluated photon-counting computed tomography (PCCT) versus conventional energy-integrating detector CT (EID-CT) for abdominal imaging in 80 participants, focusing on both radiation dose and image quality to test PCCT’s low-dose, high-quality potential. The study found that PCCT achieved improved image quality at reduced radiation dose compared with EID-CT for abdominal imaging tasks. These findings support the use of PCCT as a dose-efficient alternative to conventional CT for routine abdominal examinations where image quality is critical.

Zhu TT, Zhu XY, Yang M et al. · World journal of radiology · (2026) · View on PubMed ↗

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Spectral CT & Material Decomposition (Dual-Energy/PCCT, VMIs, Iodine Mapping)

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 of three dual-energy CT (DECT) scanners—rapid kV-switching CT (R-KVSCT), ultrafast kV-switching CT (U-KVSCT), and dual-layer CT (DLCT)—against a photon-counting CT (PCCT) scanner using virtual monoenergetic images (VMIs) at 40–70 keV and iodine maps. Across low-energy VMIs and iodine mapping, the PCCT and DECT systems showed differing spectral/iodine-map performance under standardized abdominal/pelvic parameters at a volume CT dose index of 11 mGy. These results are clinically relevant for selecting CT detector technology and reconstruction approaches to optimize low-energy spectral imaging and iodine quantification for abdominal applications.

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

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PCCT Biomarkers for Liver Function and Oncology

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

In 84 patients with primary untreated head and neck squamous cell carcinoma (HNSCC), contrast-enhanced photon-counting CT (PCCT) was used to generate iodine maps and quantify intratumoral iodine concentration via normalized iodine concentration (NIC). The study investigated associations between NIC and histopathological features including tumor stage, tumor grade, and Ki-67 proliferation index. This is clinically relevant because quantitative iodine concentration from PCCT may serve as a noninvasive imaging biomarker reflecting tumor biology and aggressiveness.

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

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

In 146 patients with chronic liver disease (CLD), this study used photon-counting detector CT (PCD-CT) to measure segmental hepatic extracellular volume fraction (fECV) from iodine densities in Couinaud liver segments (S2–S8) and the aorta during a 3-minute equilibrium phase, with prediction of early liver function decline assessed by modified albumin-bilirubin (mALBI) grade. Segmental fECV derived from PCD-CT was evaluated for diagnostic accuracy as an early predictor of mALBI-based liver function deterioration. If validated, PCD-CT–based segmental fECV could provide a quantitative, imaging biomarker to stratify CLD patients by risk of early functional decline.

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

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PCCT for Renal Mass Characterization & RCC Protocol Optimization

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

This review evaluated how spectral CT—particularly dual-energy and photon-counting CT techniques—can improve imaging of renal cell carcinoma (RCC), especially when distinguishing cystic from solid renal masses on limited-phase CT. It reports that spectral CT can reduce the number of required CT phases (e.g., in CT urography/renal CT protocols) to lower radiation dose while maintaining diagnostic accuracy and cost-effectiveness. Clinically, these protocol implications could make RCC characterization more efficient and safer by leveraging 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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PCCT for Lung Nodule Volumetry in Screening

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

A phantom study compared photon-counting detector CT (PCD-CT) versus energy-integrating detector CT (EID-CT) for lung nodule volumetric accuracy and precision under low-dose lung cancer screening protocols. PCD-CT with optimized reconstruction parameters (including slice thickness, matrix size, kernel, iterative reconstruction, and virtual monoenergetic imaging energy) improved volumetric accuracy relative to EID-CT. This supports PCD-CT as a technical route to more reliable nodule volumetry in low-dose screening, potentially improving longitudinal detection of growth.

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

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Neurovascular & Spine Vascular Applications (CSF leaks, Adamkiewicz artery, ISR)

Successful Streamlined Photon-Counting CT Myelography Protocol for Detection of CSF-Venous Fistulas in Busy Practice Settings.

In 35 adults (mean age ~51.6 years) with spontaneous intracranial hypotension and prior inconclusive imaging, a streamlined photon-counting CT myelography (PCCT myelography) protocol was developed to detect CSF-venous fistulas. The study reports successful implementation of entire-spine PCCT myelography using fluoroscopy-guided contrast injection and decubitus transport to the PCCT scanner for improved CSF leak detection. This is clinically important because it addresses practical workflow barriers and targets a known limitation of energy-integrating CT myelography (spatial resolution) in busy practice settings.

Schwartz FR, Huang RY, DeSalvo MN et al. · AJNR. American journal of neuroradiology · (2026) · View on PubMed ↗ · Free PDF ↗

Photon-Counting Detector CTA for Localization of the Artery of Adamkiewicz.

This article described the clinical application of photon-counting detector CT angiography (PCD-CTA) for localizing the artery of Adamkiewicz, the dominant feeder to the inferior anterior spinal artery. It emphasizes that the high spatial resolution of photon-counting CT can improve detection/localization in spine vascular assessment, building on prior neuroradiology uses such as spinal CSF leak detection and head/neck/spine CTA. Scientifically, it positions PCD-CTA as a promising tool to enhance pre-procedural vascular mapping in conditions where anterior spinal artery supply is critical.

Madhavan AA, Kranz PG, Kodet ML et al. · AJNR. American journal of neuroradiology · (2026) · 1 citations · View on PubMed ↗ · Free PDF ↗

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

In a prospective cohort of consecutive neurovascular stent patients, ultra-high-resolution photon-counting detector CTA (UHR PCD-CTA) was evaluated for noninvasive detection of neurovascular in-stent restenosis (ISR). The study aimed to overcome conventional CTA limitations—blooming artifacts and limited spatial resolution—by using UHR PCD-CTA reconstructions. If effective, this approach could improve ISR detection accuracy and reduce the need for invasive follow-up imaging.

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

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

This case report described a patient with a rare sacral CSF-venous fistula (right S2) and presented a novel technical modification to single-day bilateral decubitus myelography for detection. The key finding was that the modified decubitus myelography technique enabled identification of the sacral fistula that is otherwise particularly challenging to detect. This is significant because it provides a practical diagnostic approach for a rare but important cause of spontaneous intracranial hypotension.

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

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Cardiac CT: Coronary CTA Performance & Patient Experience

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

This study assessed patient-reported outcomes (PROs) and emotional experiences during coronary CT angiography (CCTA) compared with invasive coronary angiography (ICA) in 151 patients, including 69 with prior ICA, using dual-source CT or photon-counting CT of the heart. The key finding was that CCTA (including photon-counting CT) was evaluated for patient acceptance and emotional response relative to ICA based on standardized PRO measures. This matters because patient experience can influence adoption of CCTA as the preferred non-invasive strategy for excluding coronary artery disease.

von der Stück MS, Siepmann R, Corban E et al. · European journal of radiology open · (2026) · 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 health-screening participants in Taiwan (103 EID-CT in July 2024 vs 102 PCD-CT in January 2025). The key finding was an assessment of safety and effectiveness of the first-generation PCD-CT for detecting coronary artery disease relative to the contemporaneous EID-CT comparator. Clinically, this provides early real-world evidence for whether first-generation PCD-CT can improve dose efficiency and diagnostic performance for coronary CT angiography in routine screening populations.

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

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Coronary In-Stent Restenosis (ISR) with Ultralow Slice/Ultra-High Resolution PCCT

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

This two-center retrospective study evaluated ultrahigh-resolution photon-counting detector CT (UHR PCD-CT) for detecting obstructive and non-obstructive coronary in-stent restenosis (ISR) in patients with coronary stents, using invasive coronary angiography (ICA) as the reference standard. The key finding was diagnostic performance of UHR PCD-CT reconstructions at 0.2 mm slice thickness (with 0.4 mm serving as an EID-CT-like proxy) for ISR classification against ICA. Scientifically, it supports whether ultrahigh-resolution photon-counting CT can improve ISR detection accuracy for clinical coronary imaging.

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

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Metal Artifact Reduction & Postoperative Hardware Imaging

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

Tin-filtered photon-counting detector CT (PCD-CT) with high-energy virtual monoenergetic imaging (VMI) and iterative metal artifact reduction (iMAR) was assessed in postoperative anterior cervical discectomy and fusion (ACDF) patients to improve metal artifact reduction and bone fusion evaluation. The study compared standard polychromatic imaging (T3D), iMAR alone, VMI at 120 keV (VMI120), and combined VMI120 plus iMAR for quantitative/qualitative artifact metrics and intragraft/extragraft fusion assessment. This is significant because improved artifact suppression on PCD-CT may yield more reliable fusion status assessment in the presence of surgical hardware.

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

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Orthopedic & Musculoskeletal Imaging (Implants, Bone, Arthropathies)

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

Photon-counting detector CT (PCD-CT) was used longitudinally in 19 patients after total wrist arthroplasty to assess osseointegration, bone remodeling, and periprosthetic osteolysis at day 1, 6 months, and 12 months. Osseointegration (bone ingrowth to the implant) increased across most implant zones over 12 months, while periprosthetic osteolysis and bone quality metrics were evaluated using zone-based cortical thickness and density measurements. These findings support PCD-CT as a quantitative imaging tool for monitoring implant integration and osteolysis after wrist arthroplasty.

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

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

This review summarized current applications of photon-counting CT (PCCT) in musculoskeletal imaging, contrasting photon-counting detectors with energy-integrating CT detectors and highlighting capabilities such as ultra-high spatial resolution and spectral imaging. The key finding was that PCCT’s detector physics can reduce electronic noise and enable systematic spectral imaging that may improve characterization of fractures, infections, inflammatory and degenerative arthropathies, and bone marrow disorders. This is significant because it frames how PCCT could expand diagnostic accuracy across a broad range of musculoskeletal conditions.

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

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Arthritis Quantification via CT Joint Space Width (JSW)

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

This study evaluated three-dimensional joint space width (JSW) analysis from hand and wrist CT scans in an arthritis imaging context, comparing segmentation-based versus grayscale deconvolution-based methods across hand joints beyond the metacarpophalangeal joints. The key finding was that segmentation-based 3D JSW distribution analysis can be extended to additional hand/wrist joints and was compared directly against deconvolution-based approaches to assess differences in JSW quantification. This matters because more sensitive, quantitative CT-based JSW metrics could improve radiographic damage assessment and monitoring compared with traditional ordinal scoring in arthritis.

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

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Pediatric Congenital Heart Disease Imaging

Photon-counting CT angiography for anatomical assessment of patent ductus arteriosus in a child.

Photon-counting CT angiography was used to anatomically define patent ductus arteriosus in a 10-year-old girl. The scan demonstrated a ductus connecting the descending thoracic aorta to the proximal left pulmonary artery, with multiplanar and 3D reconstructions accurately depicting ductal diameter, length, and spatial relationships. This suggests photon-counting CT can complement echocardiography when detailed noninvasive ductal anatomy is required for pediatric planning.

Sun M, Ma X, Chen Y et al. · Cardiology in the young · (2026) · View on PubMed ↗

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Workflow/Protocol Development & Practical Implementation (Myelography, CBCT comparisons)

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

This phantom study compared gantry-based cone-beam CT (CBCT) of the thoracolumbar spine with dose-matched energy-integrating CT (EI-CT) and photon-counting CT (PCCT) using an anthropomorphic torso phantom. The key finding was the relative performance of the novel gantry-based multi-scan CBCT system versus EI-CT and PCCT under matched protocols for spinal imaging coverage and image quality. This is significant because it informs whether advanced CBCT can achieve spine imaging capabilities comparable to CT modalities while leveraging photon-counting benchmarks.

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

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Ultrasound-Guided Interventions with Integrated Needle Tracking (Acousto-optic sensor)

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

This bench-to-ex vivo translational 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. The key finding was that the sensor enabled in-plane needle localization in phantoms (validated with CT) and supported ex vivo bovine liver assessment of ablation margins and relative temperature estimation. This is clinically important because it could improve the safety and effectiveness of ultrasound-guided biopsy and thermal ablation by providing integrated guidance and ablation monitoring.

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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Generated automatically on June 04, 2026. Covers PubMed articles published May 28, 2026 – June 04, 2026. Summaries are AI-generated; always consult the original publication for clinical or research decisions.