Photon-Counting CT in Children: A Literature Review

Photon-counting detector computed tomography (PCD-CT) is an emerging imaging modality that offers substantial benefits in pediatric imaging, including improved spatial and contrast resolution, reduced radiation exposure, and advanced spectral imaging capabilities. This review summarizes current evidence across key pediatric body systems. In neurological imaging, PCD-CT has demonstrated superior image quality in evaluating fine temporal bone structures and reduced radiation dose, particularly in children under 6. Cardiovascular applications benefit from high-pitch dual-source acquisition and spectral imaging, improving delineation of congenital heart defects with reduced radiation and, potentially, contrast dose. Thoracic studies highlight significant radiation dose reduction while preserving diagnostic image quality in diseases such as cystic fibrosis. In abdominal imaging, PCD-CT allows consistent, high-quality imaging with simplified protocols and reduced iodinated contrast requirements, especially in challenging tasks like biliary structure visualization. Despite promising phantom and retrospective studies, research in musculoskeletal imaging remains sparse, with only limited pediatric data available. Nonetheless, PCD-CT shows potential for quantitative bone assessment, a critical application for children with chronic disease or at risk for osteoporosis. While early data are promising, significant gaps remain regarding protocol optimization, age-stratified performance, and the full utility of spectral reconstructions in pediatric imaging. Continued investigation is necessary to establish evidence-based guidelines and unlock the full clinical potential of PCD-CT in pediatric radiology.