Photon-counting CT in neuroradiology: a comprehensive SWOT analysis

Photon-counting-detector computed tomography (PCD-CT) is a disruptive technology in neuroradiology, as evidenced by the unprecedented excitement surrounding its potential clinical applications and the field's growing number of publications. By employing photon-counting detectors capable of capturing information about individual photons and measuring their energy levels, PCD-CT offers benefits over conventional energy-integrating detector (EID) CT, including a higher contrast-to-noise ratio, reduced metal artifacts, improved spatial resolution, and decreased radiation and iodine dose necessary to achieve the highest resolution images seen to date. The currently available whole-body clinical PCD-CT scanner applications in neuroradiology range from optimized bone assessment to discrimination of fine details in neurovascular evaluation. However, intrinsic barriers such as cost and technical complexity, and external factors, including a lack of protocol standardization and direct competition with other technologies, hinder the widespread adoption of PCD-CT. To analyze the current state of evidence for PCD-CT in neuroradiology, we conducted a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which may help readers and researchers to make a picture of this disruptive technology. KEY POINTS: Question A SWOT analysis of PCD-CT in neuroradiology may be useful to objectively assess its technical strengths, implementation challenges, opportunities, and threats for clinical adoption. Findings Photon-counting detector CT demonstrates superior spatial resolution, reduced artifacts, and lower radiation doses compared to conventional CT, enhancing neuroradiological imaging quality. Clinical relevance PCD-CT offers enhanced diagnostic accuracy and safety in neuroradiology, enabling better visualization of fine structures and vascular abnormalities while minimizing radiation exposure and reducing contrast agent requirements for sensitive populations.