Cardiovascular Applications of Photon-Counting CT Technology: A Revolutionary New Diagnostic Step

Abstract

Photon-counting computed tomography (PCCT) is an emerging technology that can potentially transform clinical CT imaging. After a brief description of the PCCT technology, this review summarizes its main advantages over conventional CT: improved spatial resolution, improved signal and contrast behavior, reduced electronic noise and artifacts, decreased radiation dose, and multi-energy capability with improved material discrimination. Moreover, by providing an overview of the existing literature, this review highlights how the PCCT benefits have been harnessed to enhance and broaden the diagnostic capabilities of CT for cardiovascular applications, including the detection of coronary artery calcifications, evaluation of coronary plaque extent and composition, evaluation of coronary stents, and assessment of myocardial tissue characteristics and perfusion.

Photon-Counting Detector Computed Tomography (PCD-CT): A New Era for Cardiovascular Imaging? Current Status and Future Outlooks

“…PCD-CT utilizes an innovative detector technology distinct from conventional CT [9][10][11][12][13][14]. Nowadays, most commercially available CT detectors employ standard energy-integrating detectors (EIDs), which utilize an indirect dual-step conversion process.…”

“…Even new types of contrast agents, including nanoparticles tailored to specific cells or enzymes, might be used, which would broaden the spectrum of imaging from pure anatomical to functional and molecular [12]. However, to date, these agents have only been tested in animal studies and not in humans [14].…”

“…In summary, the technical advantages of PCD-CT include a reduction in electronic noise at the same radiation dose compared to EID, and a soft tissue contrast improvement. PCD-CT weighs all photons equally; hence, it gives relatively more weight to low-energy photons compared to EID-CT, which provides more contrast information [14].…”

“…PCD-CT is a novel CT technology which has only been commercially available for 2 years. To date, over 300 publications using PCD-CT have been published, including several reviews [9][10][11][12][13][14], with an ongoing increase in the monthly publication rate. Therefore, a contemporary narrative review discussing the latest publications on the clinical potential of PCD-CT is warranted.…”

Introduction to Special Issue Imaging in Cancer Diagnosis

“…In the field of CT imaging, the recent introduction of PCCT aims to overcome the limitations of traditional CT detectors. PCCT not only enhances cardiovascular anatomy by providing better visuals of small arteries and stents, with less radiation exposure, but also is useful in oncological imaging [ 5 , 6 ].…”