[The role of photon-counting CT technology in the detection of pulmonary diseases]

Computed tomography of the chest is a cornerstone imaging modality in the diagnosis of pulmonary diseases; however, conventional systems based on energy-integrating detectors have inherent physical limitations, including restricted spatial resolution, electronic noise, and reduced image quality at low radiation doses, which may compromise diagnostic accuracy in certain clinical scenarios. Photon-counting detector computed tomography represents a novel technological approach based on the individual detection and energy discrimination of incoming X-ray photons. This enables improved dose efficiency, reduced image noise, higher spatial resolution, and intrinsic spectral imaging from a single acquisition. The aim of this review is to provide an overview of the role of photon-counting detector computed tomography in pulmonary imaging. Based on the available literature, this technology offers particular advantages in the detection and characterization of small pulmonary nodules, subsolid and ground-glass lesions, as well as in the assessment of fine morphological features of interstitial lung diseases. In addition, it improves the visualization of infectious, vascular, and traumatic pulmonary abnormalities. Spectral imaging capabilities, including virtual monoenergetic reconstructions and iodine maps, provide additional functional information on tissue perfusion, lesion characterization, and treatment response. The technique also shows promise in interventional applications by improving the visualization of target lesions and interventional devices. Photon-counting detector computed tomography represents a significant technological advancement in lung imaging. However, its widespread clinical implementation is currently limited by restricted availability, high costs, and challenges related to inter-system comparability. Nevertheless, current evidence suggests that this technology will play an increasingly important role in pulmonary diagnostics in the future. Orv Hetil. 2026; 167(30): 1186-1198.