Photon-Counting Detector CT in Cardiothoracic Imaging: AJR Expert Panel Narrative Review

Area of Science:

• Radiology and Medical Imaging
• Advanced Detector Technology
• Cardiothoracic Imaging

Background:

• Conventional energy-integrated detector (EID) CT has limitations in resolution and spectral information.
• Photon-counting detector (PCD) CT represents a significant technological leap over EID CT.
• PCD CT offers improved spatial and contrast resolution, intrinsic spectral data, and potential for dose reduction.

Purpose of the Study:

• To review the state-of-the-art cardiothoracic applications of PCD CT.
• To explore the evidence, technical features, and clinical benefits of PCD CT in cardiothoracic imaging.
• To highlight implementation challenges and future research priorities for PCD CT integration.

Main Methods:

• Narrative review of existing literature on PCD CT in cardiothoracic imaging.
• Analysis of technical features and clinical evidence supporting PCD CT applications.
• Expert panel assessment of current and future clinical utility.

Main Results:

• PCD CT provides superior visualization of pulmonary and cardiac anatomy.
• Dose reduction is achievable with PCD CT in pulmonary imaging assessments.
• PCD CT enhances coronary plaque and stent visualization, stenosis assessment, and myocardial characterization.
• Faster acquisition with PCD CT benefits pediatric and dyspneic patients.

Conclusions:

• PCD CT offers substantial advantages for cardiothoracic imaging, including improved image quality and reduced radiation dose.
• Clinical applications span pulmonary, cardiac, and coronary imaging, with significant potential benefits.
• Addressing implementation challenges and research gaps is crucial for widespread PCD CT adoption in cardiothoracic practice.