Applications of photon-counting CT in oncologic imaging: A systematic review

Photon-counting detector (PCD) CT represents a transformative advancement in radiological imaging, offering superior spatial resolution, enhanced contrast-to-noise ratio, and reduced radiation dose compared with the conventional energy-integrating detector CT.

To evaluate PCD CT in oncologic imaging, focusing on its role in tumor detection, staging, and treatment response assessment.

We performed a systematic PubMed search from January 1, 2017 to December 31, 2024, using the keywords "photon-counting CT", "cancer", and "tumor" to identify studies on its use in oncologic imaging. We included experimental studies on humans or human phantoms and excluded reviews, commentaries, editorials, non-English, animal, and non-experimental studies. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Out of 175 initial studies, 39 met the inclusion criteria after screening and full-text review. Data extraction focused on study type, country of origin, and oncologic applications of photon-counting CT. No formal risk of bias assessment was performed, and the review was not registered in PROSPERO as it did not include a meta-analysis.

Key findings highlighted the advantages of PCD CT in imaging renal masses, adrenal adenomas, ovarian cancer, breast cancer, prostate cancer, pancreatic tumors, hepatocellular carcinoma, metastases, multiple myeloma, and lung cancer. Additionally, PCD CT has demonstrated improved lesion characterization and enhanced diagnostic accuracy in oncology. Despite its promising capabilities challenges related to data processing, storage, and accessibility remain.

As PCD CT technology evolves, its integration into routine oncologic imaging has the potential to significantly enhance cancer diagnosis and patient management.