Photon-Counting Detector CT for Imaging Around Orthopedic and Spinal Metallic Implants: A Systematic Review.
6 affiliations
- 1College of Medicine, Jazan University, Jazan, SAU.
- 2College of Medicine, King Khalid University, Abha, SAU.
- 3College of Medicine, Najran University, Najran, SAU.
- 4General Surgery, King's College Hospital London, Jeddah, SAU.
- 5College of Medicine, King Faisal University, AlHofuf, SAU.
- 6Diagnostic Radiology and Nuclear Medicine, Jazan Health Cluster, Jazan, SAU.
Abstract
Metallic orthopedic and spinal implants degrade computed tomography (CT) image quality through beam hardening, photon starvation, and scatter artifacts that can obscure adjacent bone and soft tissue. Photon-counting detector CT (PCD-CT) provides intrinsic spectral data, electronic noise suppression, ultra-high spatial resolution, and high geometric dose efficiency, features that are theoretically well suited to imaging around metal. No systematic review has compared PCD-CT with energy-integrating detector CT (EID-CT) in this setting. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, and Scopus were searched on August 2, 2026, without language, date, or study-design restrictions. Eligible studies directly compared PCD-CT with EID-CT in the presence of metallic orthopedic or spinal implants in clinical, cadaveric, ex vivo, or phantom settings and reported outcomes related to image quality, metal artifacts, bone or implant-interface visualization, diagnostic confidence, image noise, or radiation dose. PCD-CT consistently reduced image noise and increased signal-to-noise and contrast-to-noise ratios in three of three studies and reduced radiation dose by approximately 45%-50% at comparable image quality in two of two direct comparisons. Bone and bone-implant interface visualization generally favored PCD-CT in three of four studies. Metal-artifact reduction was conditional: PCD-CT outperformed EID-CT when high-kiloelectron-volt (keV) virtual monoenergetic imaging (VMI), with or without iterative metal-artifact reduction (iMAR) and tin filtration, was applied, whereas PCD-CT polyenergetic images were not consistently superior and occasionally demonstrated greater streak artifacts than EID-CT. When combined with spectral post-processing, PCD-CT matches or exceeds EID-CT for imaging adjacent to orthopedic and spinal metal while approximately halving radiation dose. However, the evidence base is small and heterogeneous, and larger paired clinical studies using standardized, objective outcomes are needed.
Related
- Efficacy and safety of bone marrow aspirate and bone marrow aspirate concentrate in orthopedic conditions: a systematic review of randomized controlled trials
- Site-Specific Survival and Complications of Extra-oral Craniofacial Implants in Irradiated and Non-irradiated Patients: A Systematic Review and Meta-Analysis
- Metallic versus plastic stents for the management of biliary obstruction : A GRADE-assessed systematic review and meta-analysis
- Short Implants Versus Sinus Floor Elevation With Standard Implants in the Atrophic Posterior Maxilla: A Systematic Review and Meta-Analysis.
- Stemmed versus stemless humeral implants in anatomic total shoulder arthroplasty: a systematic review and meta-analysis.
BibTeX
@article{sabi2026photoncounting,
title = {{Photon-Counting Detector CT for Imaging Around Orthopedic and Spinal Metallic Implants: A Systematic Review.}},
author = {Ahmed Y Sabi and Yazan Y Daghriri and Nasser A Abu-Alzawayid and Mohammed A Najmi and Ashjan H Shaddawi and Mohammed M Alfaifi and Faisal O Almohaily and Mohammed A Alzahrani and Khalid M Albasheit and Mohammed I Alawad and Yahya A Hakami},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117010},
url = {https://europepmc.org/article/MED/42948782},
note = {CC BY},
}
RIS
TY - JOUR
TI - Photon-Counting Detector CT for Imaging Around Orthopedic and Spinal Metallic Implants: A Systematic Review.
AU - Ahmed Y Sabi
AU - Yazan Y Daghriri
AU - Nasser A Abu-Alzawayid
AU - Mohammed A Najmi
AU - Ashjan H Shaddawi
AU - Mohammed M Alfaifi
AU - Faisal O Almohaily
AU - Mohammed A Alzahrani
AU - Khalid M Albasheit
AU - Mohammed I Alawad
AU - Yahya A Hakami
PY - 2026
DA - 2026/09/27
JO - Cureus
DO - 10.7759/cureus.117010
UR - https://europepmc.org/article/MED/42948782
AB - Metallic orthopedic and spinal implants degrade computed tomography (CT) image quality through beam hardening, photon starvation, and scatter artifacts that can obscure adjacent bone and soft tissue. Photon-counting detector CT (PCD-CT) provides intrinsic spectral data, electronic noise suppression, ultra-high spatial resolution, and high geometric dose efficiency, features that are theoretically well suited to imaging around metal. No systematic review has compared PCD-CT with energy-integrating detector CT (EID-CT) in this setting. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, and Scopus were searched on August 2, 2026, without language, date, or study-design restrictions. Eligible studies directly compared PCD-CT with EID-CT in the presence of metallic orthopedic or spinal implants in clinical, cadaveric, ex vivo, or phantom settings and reported outcomes related to image quality, metal artifacts, bone or implant-interface visualization, diagnostic confidence, image noise, or radiation dose. PCD-CT consistently reduced image noise and increased signal-to-noise and contrast-to-noise ratios in three of three studies and reduced radiation dose by approximately 45%-50% at comparable image quality in two of two direct comparisons. Bone and bone-implant interface visualization generally favored PCD-CT in three of four studies. Metal-artifact reduction was conditional: PCD-CT outperformed EID-CT when high-kiloelectron-volt (keV) virtual monoenergetic imaging (VMI), with or without iterative metal-artifact reduction (iMAR) and tin filtration, was applied, whereas PCD-CT polyenergetic images were not consistently superior and occasionally demonstrated greater streak artifacts than EID-CT. When combined with spectral post-processing, PCD-CT matches or exceeds EID-CT for imaging adjacent to orthopedic and spinal metal while approximately halving radiation dose. However, the evidence base is small and heterogeneous, and larger paired clinical studies using standardized, objective outcomes are needed.
SN - 2168-8184
ER -