What’s New in Photon Counting CT?

October 01, 2026 · 24 articles · 15 research themes · covering September 24, 2026 – October 01, 2026

Overview

Across this week’s set, photon-counting CT (PCD-CT) is consistently framed as a platform that improves quantification—not just visualization—while also enabling dose efficiency. Multiple studies and reviews compare PCD-CT with conventional energy-integrating CT (EID-CT) and show favorable tradeoffs in dose and image quality (e.g., parathyroid 4DCT, temporal bone imaging, metal artifact reduction, and multiple myeloma bone-lesion imaging). Practical system factors—such as patient positioning/off-centering and reconstruction choices—also emerge as important determinants of performance, reinforcing that real-world benefits depend on optimizing acquisition and reconstruction, not only the detector hardware.

A second dominant theme is the move toward energy-resolved, spectral, and “virtual” imaging for quantitative biomarkers. Work on virtual non-contrast surrogates for hepatic steatosis, energy-dependent attenuation behavior in bone marrow for multiple myeloma, and Zeff/physical density estimation highlights how photon-counting’s spectral information can be converted into standardized physical measurements. Complementing this, several oncology and machine-learning efforts leverage spectral reconstructions for lesion characterization and detection (benign vs malignant liver lesions; peritoneal metastasis detectability), suggesting that spectral radiomics and tuned reconstruction settings may reduce reliance on invasive diagnostics and improve staging accuracy.

Finally, clinical translation is strongly represented in cardiovascular and procedural contexts. Studies and narrative reviews emphasize CCTA’s evolution from stenosis triage toward plaque- and physiology-informed risk stratification and PCI planning, with photon-counting CT appearing as an enabling technology for clearer coronary assessment (including stent restenosis and stress cardiomyopathy differentiation) and for more reproducible morphologic measurements (e.g., intracranial aneurysm sizing). Together, the articles point to a near-term trajectory where PCD-CT supports both better diagnostic confidence and more personalized decision-making across the care pathway.

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Photon-Counting CT (PCD-CT) vs Conventional CT: Dose & Image Quality

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 multiple myeloma patients with bone lesions, including 5 eligible studies (n=170) from 41 initially identified. The key finding was a pooled comparison of PCD-CT and EID-CT outcomes for sharpness and CTDIvol, with evidence quality assessed using ROBINS-I and GRADE. Scientifically and clinically, it clarifies whether PCD-CT can improve diagnostic image quality while reducing radiation dose in multiple myeloma imaging.

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

Impact of Vertical Off-centering on Radiation Dose and Image Noise in Photon-counting Computed Tomography: A Phantom Study.

This phantom study investigated how vertical off-centering affects radiation dose and image noise in photon-counting CT (PCCT) across adult and pediatric body sizes. Scanning anthropomorphic phantoms (adult male, 10-year-old, and 5-year-old) on a commercial PCCT system at multiple vertical offsets, it found that off-centering meaningfully changes dose and noise characteristics depending on patient size. The scientific significance is that optimizing patient positioning for PCCT could improve dose efficiency and image quality, especially for pediatric imaging.

Klüner LV, Haubold J, Peuster H et al. · Investigative radiology · (2026) · 2 citations · View on PubMed ↗

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PCD-CT Spectral/Virtual Monoenergetic Imaging & Material Quantification

Single-Phase Surrogate for True Non-Contrast Liver CT Using 190-keV Monoenergetic Imaging on Photon-Counting CT: Implications for Hepatic Steatosis Assessment.

This retrospective study assessed whether 190-keV virtual monoenergetic imaging (VMI) from photon-counting detector CT (PCD-CT) can act as a surrogate for true non-contrast (TNC) imaging for hepatic steatosis quantification, compared with virtual non-contrast (VNC), in 49 patients undergoing abdominal PCD-CT and MRI proton density fat fraction (PDFF). The key finding was that 190-keV VMI showed attenuation agreement with TNC (and was compared statistically to VNC) for segmental liver measurements used in steatosis assessment. Scientifically, it supports energy-resolved PCD-CT reconstructions as a potential single-phase approach to approximate non-contrast attenuation for quantitative fatty liver evaluation.

Ohtani T, Shimada M, Nishiyama K et al. · Academic radiology · (2026) · View on PubMed ↗ · Free PDF ↗

Energy-resolved attenuation behaviour on dual-source photon-counting CT: Implications for quantitative assessment of femoral bone marrow in multiple myeloma.

This retrospective study investigated how energy-resolved attenuation on dual-source photon-counting CT (PCD-CT) varies for femoral bone marrow and how that affects quantitative threshold-based assessment in multiple myeloma, using 103 unenhanced whole-body PCD-CT scans reconstructed at 40–190 keV. The key finding was that bone marrow attenuation behavior depends on photon energy, which has implications for how thresholds should be selected for distinguishing physiological marrow from myeloma infiltration. Scientifically, it informs more accurate quantitative imaging workflows for multiple myeloma using energy-resolved PCD-CT.

Heidemeier A, Scheiner F, Huflage H et al. · European journal of radiology · (2026) · View on PubMed ↗ · Free PDF ↗

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PCD-CT Reconstruction Optimization & Spectral Settings

Optimization of spectral photon-counting CT reconstruction parameters for improved detection of peritoneal metastases compared with energy-integrating detector dual-energy CT: a phantom study.

This phantom study optimized spectral photon-counting CT (SPCCT) reconstruction parameters to improve detection of peritoneal metastases compared with energy-integrating detector dual-energy CT (EID-DECT). Using a spectral phantom scanned at 8.5 mGy (CTDIvol), it compared SPCCT reconstruction kernels (STD-B, HRB) and iDose4 levels (i5/i7/i9/i11) for 40 keV virtual monoenergetic images against EID-DECT reconstructions, evaluating noise power spectrum (NPS), task-based transfer function (TTF), and detectability indices (d’) for non-mucinous and mucinous metastases (results truncated). The scientific significance is that selecting optimal SPCCT reconstruction settings could increase peritoneal metastasis detectability, potentially improving staging accuracy in oncology.

Greffier J, Grange R, Dabli D et al. · European radiology experimental · (2026) · View on PubMed ↗

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PCD-CT Clinical Applications: Vascular (Aneurysm, Coronary, Stents)

Photon-counting CT of midventricular takotsubo cardiomyopathy.

This case report described a 63-year-old woman with midventricular takotsubo cardiomyopathy presenting with acute chest pain and elevated troponin I after emotional stress, using photon-counting detector coronary CT angiography (PCD-CCTA). The key finding was that multiphase PCD-CCTA provided a comprehensive assessment that excluded obstructive coronary artery disease and characterized the midventricular circumferential wall-motion abnormality with basal and apical sparing. Clinically, this illustrates how photon-counting coronary CT can support rapid differentiation of stress cardiomyopathy from acute coronary syndromes.

Chikh Bakri I, Euler A · Radiology case reports · (2026) · View on PubMed ↗ · Free PDF ↗

3D Volume Rendering of Ultrahigh-Resolution Photon-Counting Detector CT Angiography for Preoperative Assessment of Intracranial Aneurysms: Initial Experience.

This retrospective study evaluated whether ultrahigh-resolution photon-counting detector CT angiography (UHR PCD-CTA) combined with 3D volume rendering (3DVR) yields reliable morphologic assessment and reproducible aneurysm size measurements in preoperative intracranial aneurysm patients (21 patients; 32 aneurysms) with two neurosurgeons reading 2D UHR and 3DVR datasets. The key finding was that the UHR PCD-CTA 3DVR workflow supported consistent aneurysm characterization and reproducible size measurements across readers. Clinically, this suggests photon-counting CT angiography with 3DVR post-processing may improve preoperative planning by providing high-fidelity, quantifiable aneurysm morphology while supporting inter-reader reliability.

Tóth A, Silbergleit M, Al Kasab S et al. · AJNR. American journal of neuroradiology · (2026) · View on PubMed ↗

Diagnostic accuracy of photon-counting detector CT for detection of coronary in-stent restenosis.

This retrospective single-center diagnostic-accuracy study assessed photon-counting detector CT (PCD-CT) for detecting significant coronary in-stent restenosis (ISR) in adults with prior coronary stenting, using invasive coronary angiography (ICA) as the reference standard. The key finding was that PCD-CT demonstrated diagnostic performance for ISR detection that was evaluated against ICA for sensitivity/specificity (details truncated in the abstract). Scientifically and clinically, the results support the potential of photon-counting CT to improve visualization of coronary stents and thereby aid noninvasive ISR detection.

Aramouni K, Kharsa C, Sarkis P et al. · Cardiovascular revascularization medicine : including molecular interventions · (2026) · View on PubMed ↗

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CCTA Beyond Stenosis: Plaque, Physiology, Prognosis & Care Pathways

Diagnostic and prognostic value of coronary computed tomography angiography and high-risk plaque assessment in acute coronary syndrome.

This review summarized evidence on the diagnostic and prognostic value of coronary CT angiography (CCTA) and high-risk plaque assessment in acute coronary syndrome (ACS), emphasizing plaque composition and high-risk features beyond luminal stenosis. The key finding was that CCTA can contribute to patient selection for invasive angiography and provide prognostic information through characterization of atherosclerotic plaque and non-coronary causes of chest pain. Clinically, it supports broader use of energy- and plaque-informed CCTA strategies to improve risk stratification in ACS.

Miceli AL, Iroulart JM, Domenech P et al. · Current problems in cardiology · (2026) · View on PubMed ↗

Advanced quantitative CT for coronary artery disease: integrating stenosis quantification, plaque quantification, and fractional flow reserve-CT.

This review studied how advanced quantitative cardiac CT angiography (CCTA)—including AI-based stenosis quantification, plaque quantification, and fractional flow reserve-CT (FFR-CT)—can be used to evaluate coronary artery disease (CAD) in clinical practice. It found that AI-enabled quantitative CT can provide more efficient, reproducible plaque biomarker assessment and streamline workflow, potentially improving risk stratification for major adverse cardiovascular events compared with stenosis-only evaluation. The clinical significance is that integrating plaque and CT-derived physiology could enable earlier, more personalized CAD management within existing CCTA pathways, though the evidence base is still evolving.

Mihalcioiu S, Mengesha B, Abitbol C et al. · The British journal of radiology · (2026) · View on PubMed ↗ · Free PDF ↗

Coronary artery calcium score-emerging role for opportunistic screening on thoracic CT and novel applications.

This review studied the emerging role of coronary artery calcium (CAC) scoring using opportunistic detection on existing thoracic CT scans (e.g., routine chest CT, lung cancer screening CT, and attenuation-correction CT) and how AI/ML may expand applications. It found that identifying CAC on thoracic CT can improve cardiovascular risk assessment and guide preventive therapy, but that randomized trials demonstrating clinical outcome benefit are currently lacking. The clinical significance is that opportunistic CAC detection could leverage existing imaging workflows for earlier CAD prevention, pending prospective evidence.

Patel R, Williams MC · The British journal of radiology · (2026) · View on PubMed ↗ · Free PDF ↗

[Coronary CT angiography: Diagnosis, prognosis and PCI planning].

This narrative review studied how coronary CT angiography (CCTA) has evolved from diagnostic triage to roles in prognosis and PCI planning. It found that CCTA improves beyond calcium scoring by visualizing non-calcified plaque and can add functional assessment via CT-derived fractional flow reserve, while prognostic value increasingly comes from overall atherosclerotic burden and high-risk plaque features (e.g., pericoronary fat) rather than stenosis severity alone, informing revisions to CAD-RADS. The clinical significance is that CCTA can guide both risk stratification and therapeutic planning across the full CAD care pathway.

Delapierre A, Tonnerre G, Mokrane FZ et al. · Annales de cardiologie et d’angeiologie · (2026) · View on PubMed ↗

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PCD-CT Clinical Applications: Musculoskeletal & Orthopedic Imaging

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

This prospective observational study assessed osseointegration, bone remodeling, and periprosthetic osteolysis after total wrist arthroplasty using photon-counting detector CT (PCD-CT) in 19 patients at day 1, 6 months, and 12 months postoperatively. The key finding was that osseointegration (bone ingrowth to the implant) increased across most zones over time, with an exception noted for the capitate, alongside quantitative measures of cortical thickness and density and zone-based osteolysis evaluation. Clinically, it demonstrates PCD-CT’s utility for detailed postoperative assessment of implant integration and bone changes after wrist arthroplasty.

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

Metal Artifact Reduction in Lumbar Spine Instrumentation: A Comparison of Photon-Counting Detector-Computed Tomography Versus Energy-Integrating Detector-Computed Tomography, Iterative Metal Artifact Reduction, and Virtual Monoenergetic Imaging in 100 Examinations.

This retrospective study compared photon-counting detector CT (PCD-CT) with energy-integrating detector CT (EID-CT), including iterative metal artifact reduction (iMAR) and virtual monoenergetic imaging (VMI) with tin (Sn) filtration, for metal artifact reduction in lumbar spine instrumentation. Across 100 clinical post-lumbar-fusion examinations (50 EID and 50 PCD), it found that PCD-CT VMI with Sn filtration and iMAR provided measurable qualitative and quantitative differences in metal artifact appearance and image quality relative to EID-CT (specific results truncated). The clinical significance is improved visualization around spinal hardware, which can support safer interpretation and follow-up after instrumentation.

Marth T, Marth AA, Abel F et al. · Investigative radiology · (2026) · 2 citations · View on PubMed ↗

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PCD-CT Clinical Applications: Temporal Bone & Otologic Imaging

Photon-counting detector computed tomography for temporal bone: does higher resolution matter?

This narrative review evaluated emerging evidence on photon-counting detector CT (PCD-CT) for temporal bone imaging, focusing on whether improved spatial resolution translates into clinically meaningful benefits compared with conventional energy-integrating detector CT (EID-CT). The key finding was that the temporal bone is an ideal test bed for submillimeter structures, and the review synthesizes how PCD-CT’s resolution/noise/dose advantages may affect diagnostic performance and decision-making. Scientifically and clinically, it frames where higher resolution is likely to matter most for otologic imaging tasks.

Epperson MV, Leng S, Lane JI et al. · Current opinion in otolaryngology & head and neck surgery · (2026) · View on PubMed ↗ · Free PDF ↗

Low-dose ultra-high-resolution temporal bone imaging using Sn100 kVp photon-counting CT: A comparative study with conventional CT.

This prospective comparative study evaluated low-dose ultra-high-resolution temporal bone imaging using Sn100 kVp tin filtration photon-counting CT (PCD-CT) versus conventional energy-integrating CT (EID-CT) in patients with suspected or confirmed temporal bone lesions. The key finding was that PCD-CT enabled dose reduction while maintaining or improving image quality at reconstructed slice thicknesses of 0.2 mm (PCD-0.2) and 0.6 mm (PCD-0.6) compared with 120 kVp EID-CT. Clinically, it supports PCD-CT as a practical approach for high-detail temporal bone imaging with lower radiation exposure.

Tong J, Tian X, Huang Y et al. · European journal of radiology · (2026) · View on PubMed ↗

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PCD-CT Clinical Applications: Airway & Pediatric Dynamic Assessment

Computed tomography of three smaller-sized supraglottic airway device prototypes in stillborn low-birth-weight neonates.

This study evaluated three smaller-sized supraglottic airway device prototypes (Neo i-gel sizes 0.65, 0.75, 0.85) versus the smallest commercially available i-gel size 1.0 in stillborn low-birth-weight neonates (>500 g) using photon-counting CT. The key finding was that photon-counting CT could anatomically position and quantify device placement relative to perilaryngeal landmarks and assess effects on adjacent structures across these prototype sizes. Clinically, this supports CT-based preclinical sizing/positioning optimization of supraglottic airways to improve neonatal resuscitation and surfactant delivery options in very small infants.

Dempsey T, Brismar TB, Svensson-Marcial A et al. · British journal of anaesthesia · (2026) · View on PubMed ↗ · Free PDF ↗

Advanced Imaging to Assess Airway Dynamics.

This review studied imaging approaches for pediatric dynamic airway assessment, comparing alternatives to endoscopy such as four-dimensional CT and photon-counting CT, as well as MRI cine and retrospectively gated techniques for conditions like tracheal collapse and obstructive sleep apnea. It found that 4D CT can objectively quantify tracheal collapse during free breathing, photon-counting CT can reduce effective dose toward radiography levels for serial monitoring, and MRI can provide radiation-free dynamic assessment with high spatial resolution without sedation in selected protocols. The scientific significance is that these modalities may improve objective, safer longitudinal evaluation of dynamic airway disorders beyond operator-dependent endoscopy.

Bates AJ, Fleck RJ, Smith DF · Otolaryngologic clinics of North America · (2026) · View on PubMed ↗

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PCD-CT Clinical Applications: Endocrine/Parathyroid Imaging

Quantitative Evaluation of Image Quality Improvement and Reduced Radiation Output with Photon-Counting CT in 4D Parathyroid Imaging.

This AJNR study quantitatively compared photon-counting CT (PCCT) versus conventional energy-integrating detector CT (EIDCT) for 4D parathyroid imaging, focusing on radiation output (CTDIvol and DLP) and image quality (signal-to-noise ratio and contrast-to-noise ratio). The key finding was that PCCT improved dose efficiency and maintained or improved image quality metrics relative to EIDCT in the context of repeated noncontrast and multiphase contrast-enhanced acquisitions. Clinically, this supports using photon-counting CT to reduce radiation exposure while preserving diagnostic image quality in anatomically complex parathyroid 4DCT examinations.

Arizono E, Buch K, Kelly HR et al. · AJNR. American journal of neuroradiology · (2026) · View on PubMed ↗ · Free PDF ↗

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PCD-CT Clinical Applications: Metabolic Risk & Body Composition

A Prediction Model for Metabolic Abnormality Clustering Based on Abdominal Body Composition Parameters From Photon-counting CT: Development and Internal Validation.

This study developed and internally validated prediction models linking abdominal body composition parameters derived from photon-counting CT (PCCT) to metabolic abnormality clustering. In 116 retrospectively enrolled abdominal PCCT patients (61 with clustering defined by ≥2 of hyperglycemia, hypertension, hypertriglyceridemia, and low HDL-C, and 55 without), it found that PCCT-derived body composition features were associated with metabolic clustering and could be used in clinical/imaging/combined risk models (performance details truncated). The clinical significance is that PCCT-based body composition metrics may enable earlier identification of patients with clustered metabolic risk using a single imaging exam.

Zhang Y, Weng S, Liu Y et al. · Academic radiology · (2026) · View on PubMed ↗

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Machine Learning/Radiomics with PCD-CT Spectral Data

Photon-counting Detector CT Spectral Reconstructions for Radiomics-based Liver Lesion Classification: A Multicenter Study.

This multicenter study evaluated whether radiomics-based machine learning using photon-counting detector CT (PCD-CT) spectral reconstructions can classify focal liver lesions as benign versus malignant. Using multispectral virtual monochromatic images and material decomposition images derived from contrast-enhanced PCD-CT, with lesion segmentation by a nnU-Net model, it found improved performance for benign/malignant differentiation compared with conventional approaches (details truncated in the abstract). The scientific significance is that PCD-CT spectral radiomics could enhance noninvasive liver lesion characterization and reduce the need for invasive diagnostic procedures.

Pietsch FL, Vellala AK, Haag F et al. · Investigative radiology · (2026) · 1 citations · View on PubMed ↗

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Quantitative Imaging for Cryopreservation/Phantoms & Experimental Models

Photon counting multi-spectral x-ray computed tomography of multi-component cryoprotectant diffusion into tissue surrogate.

This Physics in Medicine and Biology study used photon-counting multi-spectral x-ray CT (MSCT) with an empirical photon-energy bin selection technique to quantitatively measure heterogeneous diffusion of a ternary cryoprotectant cocktail—dimethyl sulfoxide (DMSO), glycerol, and water—into a hydrogel tissue surrogate. The key finding was that multi-spectral photon-counting CT enabled noninvasive, spatiotemporal quantification of cryoprotectant distribution during diffusion, leveraging energy-bin selection to improve sensitivity to the diffusing components. This is significant for cryopreservation research because it provides a quantitative imaging approach to track diffusion behavior in tissue-mimicking models without invasive sampling.

Ali AM, Parker JT, Consiglio AN et al. · Physics in medicine and biology · (2026) · View on PubMed ↗ · Free PDF ↗

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Quantitative Density/Physical Property Estimation (Zeff, ρeff)

An algorithm to calculate physical density of biomedical objects having 3 ≤ Zeff ≤ 20: an application study using clinical photon-counting computed tomography equipment.

This study developed an algorithm to calculate effective physical density (ρeff) of biomedical objects with effective atomic number (Zeff) between 3 and 20 using clinical photon-counting CT, deriving ρeff by fitting interaction cross sections to measured linear attenuation coefficients from virtual monochromatic images (VMIs). The key finding was that the proposed Zeff-informed fitting workflow enables quantitative density estimation across the specified Zeff range on photon-counting CT hardware. This is significant for quantitative imaging applications (e.g., material characterization and standardized measurements) that depend on accurate physical density mapping.

Hayashi H, Nishigami R, Asahara T et al. · Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine · (2026) · 3 citations · View on PubMed ↗ · Free PDF ↗

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CT-Guided Interventions & Procedural Planning (Including PCI)

CT-guided PCI: From diagnosis to treatment planning.

This review studied computed tomography-guided percutaneous coronary intervention (CT-guided PCI) as an extension of coronary CT angiography (CCTA) from diagnosis to procedural planning. It found that integrating morphological and CT-derived physiological information—supported by advances in myocardial mass quantification, CT-derived physiology, and 3D co-registration—can enable individualized revascularization planning before PCI, with emerging technologies like photon-counting CT expected to further improve accuracy. The clinical significance is that CT-guided PCI may improve procedural planning and potentially outcomes by better characterizing lesions and physiology pre-intervention.

Ohashi H, Tajima A, Sakai K et al. · Journal of cardiology · (2026) · View on PubMed ↗ · Free PDF ↗

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Generated automatically on October 01, 2026. Covers PubMed articles published September 24, 2026 – October 01, 2026. Summaries are AI-generated; always consult the original publication for clinical or research decisions.