Value of Ultrahigh-Resolution Photon-Counting Detector Computed Tomography in Cardiac Imaging

It was only fitting that when computed tomography (CT) was celebrating its 50th birthday since its maiden scan in 1971, it was also entering into a new generation in 2021 with the Food and Drug Administration's approval of the first photon-counting detector (PCD)-CT. As non-invasive cardiac imaging is evolving into an ever more important medical field, the introduction of this new technology promises a slew of improvements over energy-integrating detector (EID)-CTs, most importantly improved spatial resolution in the form of ultrahigh-resolution (UHR) imaging, reduced radiation exposure, and routinely acquired spectral information. Spatial resolution has historically been a key hurdle for cardiac CT, especially for coronary imaging where structures in the realm of 2 mm need to be assessed. Initial reports on the use of PCD-CT in cardiac imaging so far have been promising, but many questions ranging from standardized scan protocols to evidence-based recommendations remain. The aim of this review is to discuss the currently available literature regarding the use of UHR PCD-CT for cardiac imaging and explore if it has led to changes in guidelines or patient workflows.