Practical applications of photon-counting CT in oncology: an organ-based pictorial review
Abstract
Spectral computed tomography (CT) has become an important extension of contrast-enhanced CT (CECT) in oncologic imaging by providing material-specific information beyond conventional morphologic assessment. Dual-energy CT (DECT), implemented on energy-integrating detector CT (EID-CT) platforms, has demonstrated the value of low-keV virtual monoenergetic imaging (VMI), iodine mapping, and material decomposition for improving tumor conspicuity, delineating local extent, and supporting tissue characterization. However, broader clinical adoption of EID-CT-based DECT has been limited by increased low-keV image noise and workflow complexity. Photon-counting detector CT (PCD-CT) addresses these limitations by offering improved energy resolution, reduced electronic noise, and routine acquisition of multi-energy data without dedicated dual-energy protocols. In particular, low-keV VMI around 40 keV can be generated with clinically acceptable noise, enabling consistent enhancement-based assessment in daily practice. Iodine-based reconstructions further complement morphologic evaluation by visualizing viable tumor enhancement and enabling quantitative analysis. This organ-based pictorial review summarizes practical applications of PCD-CT–based spectral imaging in oncology. Across organ systems, spectral CT may provide complementary problem-solving information by improving lesion detection, tumor extent delineation, and diagnostic confidence, particularly when conventional CT findings are equivocal, or MRI is unavailable, contraindicated, or limited. Emerging quantitative parameters, including electron density, effective atomic number, and advanced material decomposition, may further expand oncologic CT applications, although outcome-driven validation remains limited. Together, these features position PCD-CT as a practical spectral imaging platform for routine oncologic CT.
Key Points: Question How can PCD-CT address low-keV image noise and workflow barriers that have limited routine DECT-based spectral imaging in oncologic CT practice?
Findings PCD-CT enables low-keV VMI and iodine-based reconstructions that may improve lesion conspicuity, tumor-extent assessment, and problem-solving across organ-specific oncologic workflows.
Critical relevance statement This review clarifies practical, evidence-aware uses of PCD-CT spectral reconstructions in oncology, highlighting low-keV VMI as an adjunct, selective iodine-map problem-solving, and investigational quantitative parameters.
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BibTeX
@article{kawasaki2026practical,
title = {{Practical applications of photon-counting CT in oncology: an organ-based pictorial review}},
author = {Yusuke Kawasaki and Kota Yokoyama and Hiroto Hada and Hirofumi Yamada and Junichi Tsuchiya and Kurara Yamamoto and Iichiroh Onishi and Yosuke Ariizumi and Takayuki Honda and Kenichi Okubo and Tomoyuki Aruga and Daisuke Asano and Daisuke Ban and Soichiro Yoshida and Yasuhisa Fujii and Kimio Wakana and Marie Hanaoka and Keisuke Tanaka and Masahide Yamamoto and Takehiko Mori and Sadakatsu Ikeda and Ukihide Tateishi},
journal = {Insights into imaging},
year = {2026},
month = oct,
doi = {10.1186/s13244-026-02399-x},
url = {https://europepmc.org/article/PMC/PMC13652996},
note = {CC BY},
}
RIS
TY - JOUR
TI - Practical applications of photon-counting CT in oncology: an organ-based pictorial review
AU - Yusuke Kawasaki
AU - Kota Yokoyama
AU - Hiroto Hada
AU - Hirofumi Yamada
AU - Junichi Tsuchiya
AU - Kurara Yamamoto
AU - Iichiroh Onishi
AU - Yosuke Ariizumi
AU - Takayuki Honda
AU - Kenichi Okubo
AU - Tomoyuki Aruga
AU - Daisuke Asano
AU - Daisuke Ban
AU - Soichiro Yoshida
AU - Yasuhisa Fujii
AU - Kimio Wakana
AU - Marie Hanaoka
AU - Keisuke Tanaka
AU - Masahide Yamamoto
AU - Takehiko Mori
AU - Sadakatsu Ikeda
AU - Ukihide Tateishi
PY - 2026
DA - 2026/10/09
JO - Insights into imaging
DO - 10.1186/s13244-026-02399-x
UR - https://europepmc.org/article/PMC/PMC13652996
AB - Spectral computed tomography (CT) has become an important extension of contrast-enhanced CT (CECT) in oncologic imaging by providing material-specific information beyond conventional morphologic assessment. Dual-energy CT (DECT), implemented on energy-integrating detector CT (EID-CT) platforms, has demonstrated the value of low-keV virtual monoenergetic imaging (VMI), iodine mapping, and material decomposition for improving tumor conspicuity, delineating local extent, and supporting tissue characterization. However, broader clinical adoption of EID-CT-based DECT has been limited by increased low-keV image noise and workflow complexity. Photon-counting detector CT (PCD-CT) addresses these limitations by offering improved energy resolution, reduced electronic noise, and routine acquisition of multi-energy data without dedicated dual-energy protocols. In particular, low-keV VMI around 40 keV can be generated with clinically acceptable noise, enabling consistent enhancement-based assessment in daily practice. Iodine-based reconstructions further complement morphologic evaluation by visualizing viable tumor enhancement and enabling quantitative analysis. This organ-based pictorial review summarizes practical applications of PCD-CT–based spectral imaging in oncology. Across organ systems, spectral CT may provide complementary problem-solving information by improving lesion detection, tumor extent delineation, and diagnostic confidence, particularly when conventional CT findings are equivocal, or MRI is unavailable, contraindicated, or limited. Emerging quantitative parameters, including electron density, effective atomic number, and advanced material decomposition, may further expand oncologic CT applications, although outcome-driven validation remains limited. Together, these features position PCD-CT as a practical spectral imaging platform for routine oncologic CT. Key Points: Question How can PCD-CT address low-keV image noise and workflow barriers that have limited routine DECT-based spectral imaging in oncologic CT practice? Findings PCD-CT enables low-keV VMI and iodine-based reconstructions that may improve lesion conspicuity, tumor-extent assessment, and problem-solving across organ-specific oncologic workflows. Critical relevance statement This review clarifies practical, evidence-aware uses of PCD-CT spectral reconstructions in oncology, highlighting low-keV VMI as an adjunct, selective iodine-map problem-solving, and investigational quantitative parameters.
SN - 1869-4101
ER -