Photon-counting detector CT in oncology: a new era of cancer imaging

Oncologic imaging plays a critical role in the diagnosis, staging, treatment planning, and follow-up of cancer patients. Recent advancements in computed tomography, particularly the development of photon-counting detector CT (PCCT), have introduced new opportunities for improving diagnostic accuracy and tissue characterization, while reducing contrast agent usage and radiation exposure. By offering ultra-high spatial resolution, enhanced contrast-to-noise ratio, and intrinsic spectral capabilities, PCCT addresses many limitations of conventional energy-integrating detector CT (EID-CT) and unlocks new possibilities for quantitative imaging. This review explores the emerging applications of PCCT across various tumor types-including thoracic, abdominal, and musculoskeletal malignancies-highlighting its potential to improve cancer imaging and patient care. CRITICAL RELEVANCE STATEMENT: Photon-counting detector CT (PCCT) offers several advantages in oncologic imaging, providing superior spatial resolution, spectral imaging capabilities, and reduced radiation dose, enhancing lesion characterization and precise treatment planning, making PCCT a valuable tool for personalized cancer care. KEY POINTS: CT has a crucial role in oncological imaging, supporting diagnosis, staging, treatment planning and follow-up. Compared to EID-CT, PCCT offers higher spatial and contrast resolution, reduces artifacts and image noise and provides spectral data enabling quantitative assessment. PCCT may improve cancer imaging by increasing diagnostic accuracy, with better detection of small lesions, enhanced soft tissue contrast, and enabling quantitative iodine uptake evaluation.