Photon-counting detector computed tomography in thoracic oncology: revolutionizing tumor imaging through precision and detail.

Journal: Diagnostic and interventional radiology (Ankara, Turkey)
Published Date: Sep 24, 2025

Abstract

Photon-counting detector computed tomography (PCD-CT) is an emerging imaging technology that promises to overcome the limitations of conventional energy-integrating detector (EID)-CT, particularly in thoracic oncology. This narrative review summarizes technical advances and clinical applications of PCD-CT in the thorax with emphasis on spatial resolution, dose-image-quality balance, and intrinsic spectral imaging, and it outlines practical implications relevant to thoracic oncology. A literature review of PubMed through May 31, 2025, was conducted using combinations of "photon counting," "computed tomography," "thoracic oncology," and "artificial intelligence." We screened the retrieved records and included studies with direct relevance to lung and mediastinal tumors, image quality, radiation dose, spectral/iodine imaging, or artificial intelligence-based reconstruction; case reports, editorials, and animal-only or purely methodological reports were excluded. PCD-CT demonstrated superior spatial resolution compared with EID-CT, enabling clearer visualization of fine pulmonary structures, such as bronchioles and subsolid nodules; slice thicknesses of approximately 0.4 mm and ex vivo resolvable structures approaching 0.11 mm have been reported. Across intraindividual clinical comparisons, radiation-dose reductions of 16%-43% have been achieved while maintaining or improving diagnostic image quality. Intrinsic spectral imaging enables accurate iodine mapping and low-keV virtual monoenergetic images and has shown quantitative advantages versus dual-energy CT in phantoms and early clinical work. Artificial intelligence-based deep-learning reconstruction and super-resolution can complement detector capabilities to reduce noise and stabilize fine-structure depiction without increasing dose. Potential reductions in contrast volume are biologically plausible given improved low-keV contrast-to-noise ratio, although clinical dose-finding data remain limited, and routine K-edge imaging has not yet translated to clinical thoracic practice. In conclusion, PCD-CT provides higher spatial and spectral fidelity at lower or comparable doses, supporting earlier and more precise tumor detection and characterization; future work should prioritize outcome-oriented trials, protocol harmonization, and implementation studies aligned with "Green Radiology".

Authors

  • Masahiro Yanagawa
    Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
  • Midori Ueno
    Department of Radiology, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, Fukuoka, 807-8555, Japan.
  • Rintaro Ito
    Department of Innovative Biomedical Visualization, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
  • Daiju Ueda
    Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan. [email protected].
  • Tsukasa Saida
    Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
  • Ryo Kurokawa
    Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Koji Takumi
    Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
  • Kentaro Nishioka
    Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
  • Shunsuke Sugawara
    Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
  • Satoru Ide
    Department of Radiology, University of Occupational and Environmental Health, School of Medicine.
  • Maya Honda
    From the Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan (M.I.); Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.I., M.K., M.H., Y.N.); A.I. System Research, Kyoto, Japan (R.M.); Kyoto University Faculty of Medicine, Kyoto, Japan (K.T., T.Y.); Department of Diagnostic Radiology, Kyoto City Hospital, Kyoto, Japan (A.M.); Department of Diagnostic Radiology, Kansai Electric Power Hospital, Osaka, Japan (M.H.); e-Growth, Kyoto, Japan (K.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.).
  • Mami Iima
    Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
  • Mariko Kawamura
    Department of Radiology, Nagoya University Graduate School of Medicine.
  • Akihiko Sakata
    Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku Kyoto 606-8507, Japan.
  • Keitaro Sofue
    Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
  • Seitaro Oda
    Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan (T.N., N.Y., N.K., Y.N., H.U., M.K., S.O., T.H.).
  • Tadashi Watabe
    Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan.
  • Kenji Hirata
    Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
  • Shinji Naganawa
    Department of Radiology, Nagoya University Graduate School of Medicine.

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