What’s New in Photon Counting CT?

October 08, 2026 · 26 articles · 15 research themes · covering October 01, 2026 – October 08, 2026

Overview

Across this week’s PubMed set, photon-counting CT (PCD-CT) is consistently positioned as a next-generation imaging platform that improves diagnostic performance while reducing radiation dose and/or contrast burden. Multiple studies and reviews report better dose efficiency and/or image quality compared with energy-integrating CT (EID-CT), including in anatomically challenging settings such as parathyroid 4DCT, temporal bone imaging, and repeated myeloma-related CT surveillance. Dose and protocol optimization also emerges as a major theme: off-centering effects, low-dose/low-iodine angiography strategies, and endoleak surveillance at reduced dose fractions all aim to preserve clinically critical detectability.

A second dominant theme is the added value of PCD-CT’s spectral capabilities—particularly virtual monoenergetic imaging (VMI) and related reconstructions—for quantitative tissue and vascular assessment. Studies on hepatic steatosis suggest that specific VMI energies can approximate true non-contrast measurements, while multiple myeloma work highlights that energy-dependent attenuation must be accounted for when deriving quantitative biomarkers. In vascular imaging, appropriate VMI energy selection supports adequate arterial contrast in trauma and robust endoleak detection even at substantially reduced dose, reinforcing the idea that “spectral tuning” can substitute for more burdensome acquisition strategies.

Finally, several articles show how PCD-CT workflows are moving beyond raw image quality toward decision support and procedural planning. Radiomics/AI models using PCD-CT spectral reconstructions improve benign-versus-malignant liver lesion classification, while coronary-focused reviews emphasize plaque characterization and quantitative CT approaches (including FFR-CT concepts) for risk stratification. Practical workflow papers also extend CCTA into CT-guided PCI planning, and PCD-CT angiography reconstruction optimization supports automated vessel tracing for prostate artery embolization—together illustrating a shift from imaging as observation toward imaging as an actionable planning tool.

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Photon-counting CT (PCD-CT) vs energy-integrating CT (EID-CT): image quality & dose

Photon-Counting Detector CT in Cardiothoracic Imaging: AJR Expert Panel Narrative Review.

This AJR Expert Panel narrative review studied the clinical and technical impact of photon-counting detector (PCD) CT versus conventional energy-integrating detector (EID) CT across cardiothoracic imaging scenarios. It found that PCD CT improves spatial/contrast resolution and provides intrinsic spectral information, enabling potential reductions in radiation dose and iodinated contrast volume while enhancing visualization of pulmonary and cardiac anatomy. These findings support broader clinical adoption of PCD CT for cardiothoracic assessment by leveraging spectral and high-resolution capabilities to improve diagnostic performance and patient safety.

Milos RI, Siegel MJ, Bluemke DA et al. · AJR. American journal of roentgenology · (2026) · 1 citations · View on PubMed ↗

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

This narrative review evaluated whether the higher spatial resolution of photon-counting detector CT (PCD-CT) meaningfully improves temporal bone imaging outcomes compared with energy-integrating detector CT (EID-CT). The key finding was that while PCD-CT offers improved noise and submillimeter detail, the clinical impact depends on which temporal bone structures are targeted and whether resolution gains translate into improved diagnostic decisions. This is significant for guiding adoption and optimizing imaging protocols in otolaryngology where many relevant anatomy features are submillimeter.

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

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

This methodological study proposed an algorithm to calculate effective physical density (ρeff) for biomedical objects with effective atomic number (Zeff) between 3 and 20, using clinical photon-counting CT equipment. The key finding was that ρeff could be derived by fitting interaction cross sections (σs) to measured linear attenuation coefficients (μs) from virtual monochromatic images (VMIs), with Zeff used as an input to improve the density estimation. This is significant because it advances quantitative imaging capabilities of photon-counting CT for material/biophysical characterization relevant to biomedical research and potential clinical applications.

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 ↗

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 photon-counting detector CT (PCD-CT) at Sn100 kVp in patients with suspected or confirmed temporal bone lesions, compared with conventional energy-integrating detector CT (EID-CT). The key finding was that PCD-CT enabled radiation dose reduction while maintaining or improving image quality for temporal bone assessment using 0.2 mm and 0.6 mm reconstructions. Scientifically and clinically, it supports PCD-CT as a lower-dose alternative for high-detail temporal bone imaging.

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

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 bone lesions from multiple myeloma. The key finding was that across included studies (5 studies, n=170), PCD-CT can improve or maintain image quality while reducing radiation dose metrics such as CTDIvol. This is significant for optimizing imaging protocols in multiple myeloma patients who require repeated whole-body CT assessments.

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

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

This quantitative study compared photon-counting CT (PCCT) with conventional energy-integrating detector CT (EIDCT) for image quality and radiation output in parathyroid 4-dimensional CT (4DCT) across repeated noncontrast and multiphase contrast acquisitions. The key finding was that PCCT improved dose efficiency and/or image quality metrics (including SNR and contrast-to-noise ratio) while reducing scanner radiation output measures such as CTDIvol and DLP (specific values truncated). This is significant because it supports adopting PCCT to mitigate the higher radiation burden of parathyroid 4DCT while preserving diagnostic image quality in the anatomically complex neck.

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 spectral/virtual monoenergetic/material decomposition for tissue characterization

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 of 49 patients compared attenuation from 190-keV virtual monoenergetic imaging (VMI) on photon-counting CT (PCD-CT) against true non-contrast (TNC) liver CT and virtual non-contrast (VNC) reconstructions for hepatic steatosis assessment, using MRI proton density fat fraction (PDFF) as the clinical reference context. The key finding was that 190-keV VMI attenuation could function as a practical surrogate for TNC in hepatic steatosis quantification, showing agreement with TNC attenuation measurements. This is clinically significant because it may enable steatosis assessment without requiring true non-contrast scans, reducing patient burden and scan complexity.

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

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Radiomics & AI for lesion classification using PCD-CT

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) multispectral virtual monochromatic and material-decomposition images can differentiate benign versus malignant focal liver lesions in patients scanned at two institutions. The key finding was that PCD-CT spectral reconstructions improved radiomics-based classification performance for liver lesion malignancy compared with conventional CT approaches (details truncated in the abstract). This supports using PCD-CT spectral imaging plus nnU-Net–based lesion segmentation to improve noninvasive liver cancer risk stratification and potentially reduce the need for invasive diagnostics.

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

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Coronary CT angiography (CCTA): plaque, FFR-CT, and high-risk features

Photon-counting CT of midventricular takotsubo cardiomyopathy.

This case report described photon-counting detector coronary CT angiography (PCD-CCTA) in a 63-year-old woman with midventricular takotsubo cardiomyopathy presenting with acute chest pain and elevated cardiac troponin I after emotional stress. The key finding was that PCD-CCTA provided a comprehensive evaluation that excluded obstructive coronary artery disease and, with multiphase cine reconstructions, characterized the midventricular wall-motion abnormality pattern. This is significant because it illustrates how high-resolution PCD-CCTA can support rapid, accurate differentiation of stress cardiomyopathy from coronary obstruction in acute settings.

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

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

This review studied the diagnostic and prognostic utility of coronary computed tomography angiography (CCTA) with high-risk plaque assessment in patients presenting with acute coronary syndrome (ACS). It found that CCTA can characterize atherosclerotic plaque composition and identify high-risk plaque features beyond detecting coronary stenosis, supporting improved selection for invasive coronary angiography and risk stratification. Clinically, this supports broader use of plaque-focused CCTA to refine ACS evaluation and potentially improve outcomes through earlier, more targeted management.

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 advanced quantitative CT approaches for coronary artery disease, integrating stenosis quantification, plaque quantification, and fractional flow reserve-CT (FFR-CT) derived from CCTA. The key finding was that AI-based quantitative CT can reduce interobserver variability and enable reproducible plaque biomarker analysis to support more refined risk stratification for major adverse cardiovascular events. Scientifically and clinically, it positions quantitative plaque-focused CCTA workflows as a step toward more personalized CAD management beyond simple stenosis grading.

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 (including routine thoracic CT, lung cancer screening CT, and attenuation correction CT). The key finding was that identifying CAC on thoracic CT can improve cardiovascular risk assessment and help identify patients who may benefit from preventive therapies, despite the lack of randomized trials proving clinical impact. Clinically, it highlights a practical pathway to integrate cardiovascular prevention into current imaging workflows using AI/ML-enabled CAC detection.

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

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CT-guided coronary intervention workflow and procedural planning

CT-guided PCI: From diagnosis to treatment planning.

This article reviewed the clinical workflow of computed tomography-guided percutaneous coronary intervention (CT-guided PCI), focusing on how coronary CT angiography (CCTA) integrates morphological and CT-derived physiological information to plan individualized revascularization. The key finding is that CT-guided PCI extends CCTA from diagnosis to procedural planning by incorporating myocardial mass quantification, CT-derived physiology, and 3D co-registration, with emerging photon-counting CT expected to further refine accuracy and applicability. This is significant because it frames how next-generation CT (including photon-counting CT) could improve patient selection and procedural planning for PCI.

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

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PCD-CT angiography optimization (aorta, peripheral, trauma) & iodine dose reduction

Retrospective assessment of low-dose and low-contrast agent protocols for photon-counting CT angiography of the aorta.

This retrospective study assessed dedicated low-dose (LD) and low-contrast (LC) protocols for photon-counting CT angiography of the aorta in 57 patients, comparing them with standard protocols on both PCD-CT and energy-integrating CT (EID-CT). The key finding was that protocol-specific reductions in iodine dose (14 mg for LC, 21 mg for LD) and combined LD/LC strategies can preserve aortic CTA image quality within defined image-quality levels (IQ), relative to standard scanning. This is significant because it informs how to optimize PCD-CT aortic angiography to reduce radiation/iodine burden while maintaining diagnostic performance.

Hennes JL, Krompaß K, Huflage H et al. · The international journal of cardiovascular imaging · (2026) · View on PubMed ↗ · Free PDF ↗

Impact of virtual monoenergetic images on the assessability of lower extremity arteries in (Poly-) trauma photon-counting detector CT.

This study evaluated whether virtual monoenergetic (VME) reconstructions from photon-counting detector CT (PCD-CT) provide sufficient vascular contrast (>200 HU) for assessability of lower extremity arteries in (poly-)trauma patients undergoing extended leg CT. The key finding was that specific VME energy levels can achieve adequate arterial contrast for vascular evaluation in the trauma setting. This is clinically important because it supports using PCD-CT VME reconstructions to improve noninvasive detection of lower-extremity vascular pathology after severe trauma.

Dillinger D, Bauer C, Kaatsch HL et al. · Emergency radiology · (2026) · View on PubMed ↗ · Free PDF ↗

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Radiation dose reduction strategies in PCD-CT protocols

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

This phantom study quantified how vertical off-centering affects radiation dose and image noise in photon-counting CT (PCCT) across adult and pediatric body sizes using anthropomorphic phantoms. The key finding was that vertical off-centering measurably changed dose and image noise depending on phantom size, demonstrating that patient positioning can influence PCCT performance (numerical results truncated). This is significant because it informs positioning protocols to optimize image quality and minimize dose in clinical PCCT, especially for pediatric imaging.

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

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Metal artifact reduction and hardware imaging with PCD-CT

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 analysis compared photon-counting detector CT (PCD-CT) versus energy-integrating detector CT (EID-CT), including iterative metal artifact reduction (iMAR) and virtual monoenergetic imaging (VMI) strategies, for metal artifact reduction in 100 lumbar spine instrumentation examinations after fusion surgery. The key finding was that PCD-CT–based spectral reconstructions (including tin-prefiltration, Sn, and VMI) provided improved artifact suppression and/or quantitative image quality relative to EID-CT approaches (exact comparative metrics truncated). This is scientifically and clinically significant because it indicates photon-counting spectral CT may enhance visualization around spinal hardware, improving assessment of postoperative anatomy and complications.

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

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Neuroimaging with PCD-CT (myelography, intracranial hypotension)

Photon-Counting Detector vs Energy-Integrating Detector CT Myelography for Detecting CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: Substantially Lower Radiation Dose.

This retrospective single-center cohort study compared photon-counting detector CT myelography (PCD-CTM) versus energy-integrating detector CT myelography (EID-CTM) for detecting cerebrospinal fluid–venous fistulas (CVFs) in patients with spontaneous intracranial hypotension (SIH). The key finding was that PCD-CTM achieved substantially lower session dose-length product (DLP) than EID-CTM while maintaining the ability to detect CVFs (full quantitative results truncated). This is clinically significant because it suggests photon-counting CT can reduce radiation exposure in SIH patients undergoing multiacquisition CT myelography.

Christensen S, Kranz PG, Malinzak MD et al. · AJNR. American journal of neuroradiology · (2026) · 1 citations · View on PubMed ↗ · Free PDF ↗

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Musculoskeletal imaging with PCD-CT (bone marrow, marrow fat, implants)

Quantitative assessment of vertebral bone marrow adipose tissue using photon-counting CT compared with MRI.

This prospective study evaluated photon-counting CT (PCCT)–derived parameters for quantifying vertebral bone marrow adipose tissue (BMAT) in adult participants with low back pain, using MRI proton density fat fraction (PDFF) from a 6-echo q-Dixon sequence as the reference. The key finding was that PCCT metrics—virtual non-calcium (VNCa) CT values, VNCa CT fat fraction (CTFF), and standardized 70 keV CT values—showed measurable correlation/agreement with MRI PDFF at vertebral and subject levels. This supports PCCT as a potentially accurate, noninvasive alternative for BMAT quantification that could improve musculoskeletal risk stratification and monitoring.

Shu D, Wang J, Liang D et al. · European journal of radiology · (2026) · View on PubMed ↗

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Quantitative CT biomarkers in multiple myeloma (marrow energy dependence)

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

This retrospective single-center study investigated energy-resolved attenuation behavior of femoral bone marrow on virtual monoenergetic images derived from dual-source photon-counting CT (PCD-CT) in 103 patients with multiple myeloma. The key finding was that bone marrow attenuation varies with photon energy (VMI keV range 40–190 keV), which can affect threshold-based quantification used to distinguish physiological marrow from myeloma infiltration. Scientifically, it highlights the need to account for energy dependence when performing quantitative CT biomarkers in multiple myeloma.

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

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Orthopedic arthroplasty and implant integration/osteolysis monitoring

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

This prospective longitudinal study evaluated osseointegration, bone remodeling, and periprosthetic osteolysis after total wrist arthroplasty using photon-counting detector CT (PCD-CT) in 19 patients. The key finding was that osseointegration (bone ingrowth to the implant) increased over follow-up in most evaluated zones, while cortical thickness/density and osteolysis were measurable around the implant at postoperative time points (day 1, 6 months, 12 months). Clinically, it supports PCD-CT as a tool for monitoring implant integration and periprosthetic bone changes after wrist arthroplasty.

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

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Oncology imaging with PCD-CT (liver/HCC, prostate embolization planning, residual tumor)

Optimizing photon counting detector CT reconstructions for automatic vessel tracing in prostate artery embolization.

This study in 10 patients undergoing prostate artery embolization (PAE) used photon-counting detector CT (PCD-CT) angiography to determine which reconstruction method most robustly supports automatic vessel tracing for procedural planning. It found that among four evaluated reconstruction approaches (varying reconstruction settings), one reconstruction provided the most consistent and reliable automatic vessel tracing performance within the PCD-CT workflow. This is clinically significant because optimized PCD-CT reconstructions could streamline automated vascular navigation and improve planning accuracy for PAE.

Froelich T, Linch FB, Thompson SM et al. · Journal of applied clinical medical physics · (2026) · View on PubMed ↗

Photon-counting detector CT for follow-up after TACE in hepatocellular carcinoma: effects of reconstruction kernel and sharpness.

This retrospective study of 72 hepatocellular carcinoma (HCC) patients assessed how photon-counting detector CT (PCD-CT) reconstruction kernel type (body regular [Br] vs quantitative regular [Qr]) and sharpness levels (36–48) affect post–transarterial chemoembolization (TACE) imaging of residual viable tumor conspicuity. The key finding was that reconstruction kernel and sharpness meaningfully changed image noise and signal-to-noise characteristics, thereby influencing the detectability/contrast of residual viable tumor. This is important for optimizing PCD-CT reconstruction parameters to improve follow-up assessment after TACE and potentially guide timely clinical management.

Yuan M, Wang D, Shi Z et al. · Abdominal radiology (New York) · (2026) · View on PubMed ↗ · Free PDF ↗

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Vascular endoleak detection & endovascular surveillance with PCD-CT

Endoleak detection with photon-counting detector CT at various radiation doses after endovascular aneurysm repair: a phantom study.

This phantom study investigated endoleak detectability with photon-counting detector CT (PCD-CT) at reduced radiation doses after endovascular aneurysm repair, using 55 keV and 50 keV virtual monoenergetic images (VMIs). It found that small iodinated endoleaks (2–6 mm) remained highly detectable at specific lower dose fractions (including 25% and 12.5% dose) when reconstructed with appropriate VMIs, compared with standard-dose imaging. This is significant because it identifies dose thresholds for safer lifelong surveillance CT while preserving sensitivity for clinically critical endoleaks.

Huber AT, Szucs-Farkas G, Perrin LG et al. · The international journal of cardiovascular imaging · (2026) · View on PubMed ↗ · Free PDF ↗

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Pediatric airway dynamics and neonatal device positioning using PCD-CT

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

This experimental imaging study evaluated three smaller supraglottic airway device prototypes (including Neo i-gel sizes 0.65, 0.75, 0.85 and the smallest commercial i-gel size 1.0) in stillborn low-birth-weight neonates using photon-counting CT to assess device positioning. The key finding was that photon-counting CT enabled precise measurement of placement relative to perilaryngeal landmarks and characterization of effects on adjacent structures across the tested device sizes. This is scientifically and clinically significant because it provides high-resolution, quantitative guidance for selecting airway devices in extremely small neonates where conventional options are limited.

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 narrative review studied imaging methods for assessing pediatric airway dynamics, contrasting endoscopy with dynamic CT and MRI approaches. The key finding was that four-dimensional CT can quantify tracheal collapse during free breathing, photon-counting CT can achieve effective doses approaching chest radiography for serial monitoring, and MRI techniques can provide radiation-free dynamic assessment. This is significant because it supports safer, more objective imaging alternatives for monitoring dynamic airway disorders in children.

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

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Generated automatically on October 08, 2026. Covers PubMed articles published October 01, 2026 – October 08, 2026. Summaries are AI-generated; always consult the original publication for clinical or research decisions.