Initial clinical evaluation of photon-counting detector computed tomography for coronary artery disease in Taiwan

Photon-counting detector computed tomography (PCD-CT) is an emerging technology that improves dose efficiency, image resolution, and noise performance. We aimed to compare the safety and effectiveness of the first-generation PCD-CT with a third-generation energy-integrating detector computed tomography (EID-CT) for the detection of coronary artery disease in the participants from a health check programme in Taiwan.

In this retrospective, single-centre study, we included 205 asymptomatic individuals undergoing coronary computed tomography angiography as part of their health screening: 103 with EID-CT in July 2024 and 102 with PCD-CT in January 2025. All scans were acquired using the helical mode. Radiation exposure, iodinated contrast volume, and referral outcomes were compared between those scanned with PCD-CT and with EID-CT.

Baseline characteristics were generally balanced between the two groups except for height, smoking habit, and plasma lipid and glucose concentrations. The PCD-CT group had a lower radiation dose indexed by dose length product (401.0 vs. 633.6 mGy·cm and 421.5 vs. 690.0 mGy·cm for the main scan and for the total procedure, respectively; both P  < 0.001) but received higher contrast volume (65.0 vs. 49.0 ml; P  < 0.001), as compared with the EID-CT group. All images were of good diagnostic quality, and the rates of referral to invasive coronary angiography (3.9 vs. 4.9%) were similar between the two groups ( P  > 0.999).

The first-generation PCD-CT, compared with a third-generation EID-CT, offered a substantial reduction in radiation exposure without additional needs for invasive cardiac catheterisation. Further studies using contrast-optimisation technologies and dose-optimisation strategies are warranted to assess diagnostic quality.