Photon-counting CT in tumor imaging: A review of comparative evaluations and technical innovations

Malignant tumors remain a major global public health challenge, and the limitations of conventional energy-integrating detector computed tomography (EID-CT) in spatial resolution, early lesion detection, and quantitative analysis continue to constrain precise diagnosis and treatment of tumors. Photon-counting computed tomography (PCCT), an emerging CT technology, has shown promising potential in tumor imaging. In this study, the literature on PCCT in oncologic imaging was searched and screened. Existing reviews lack an integrated analysis of comparative evaluation and technological innovation for oncological applications, with insufficient large-sample clinical evidence and discussion of multimodal imaging-AI integration. Regarding these issues, the included literature was classified and analyzed based on comparative evaluation research and technological innovation research. First, the medical background and theoretical basis of PCCT in tumor imaging are introduced. Subsequently, recent relevant studies are reviewed from the perspectives of comparative evaluation and technological innovation. Finally, the current research status and development trends in this field are analyzed and discussed. PCCT achieves high-resolution, low-dose, spectral tumor imaging for lesion detection and tissue characterization. Therefore, PCCT may support precise imaging diagnosis and personalized tumor treatment.