Photon-Counting Computed Tomography in Cardiac Imaging

Coronary computed tomography angiography plays a pivotal role in the diagnosis, risk stratification, and treatment of patients with known or suspected coronary artery disease. However, conventional computed tomography (CT) technologies are limited by spatial resolution, artifact susceptibility, and radiation exposure. Photon-counting computed tomography (PCCT) introduces substantial technological improvements over conventional CT. This includes improved spatial and contrast resolution, energy discrimination, and reduction of various artifacts. As a result, PCCT enables superior coronary lumen and plaque evaluation, even in complex cases with severe calcification or smaller coronary stents. Beyond the coronary arteries, PCCT offers improved visualization of cardiac anatomy and myocardial tissue characterization with the potential to reduce downstream testing, improve diagnosis and treatment, and ultimately improve clinical outcomes. PCCT is poised to become the dominant technology for cardiovascular CT; however, challenges such as high costs, increased data demands, and a need for more validation, standardized image acquisition, and post-processing protocols remain. This review explores the technical principles of PCCT, its advantages over conventional CT, and its current and potential future applications in cardiac imaging, highlighting opportunities for future research.