Newly published prospective research demonstrates that photon-counting computed tomography (PCCT) offers better detection of malignant features and higher image quality than energy-integrating CT (EID CT) at over a 66 percent lower radiation dose for patients with lung cancer.
For the prospective study, recently published in Radiology, researchers assessed detection of malignant features and image quality as well as radiation and iodine exposure in a comparison of PCCT and EID CT in a propensity matched cohort of 200 patients with lung cancer (mean age of 61.66).
The researchers found that utilizing a 0.4 mm slice thickness with PCCT offered a wider range of detection for malignant features (291-340 findings) in comparison to EID CT (194-255 findings).
Specifically, in a comparison of EID-CT at 5 mm, EID-CT at 1 mm, PCCT at 5 mm, PCCT at 1 mm and PCCT at 0.4 mm, the study authors found that PCCT at 0.4 mm detected the highest number of angiogram signs (18) and cases involving vessel convergence or invasion (37). The use of PCCT at 0.4 mm slices also offered the highest detection for cases involving lobulation (34) and bronchial stenosis (63), according to the researchers.
“ … Our research demonstrated that 1-mm and 0.4-mm UHR PCCT significantly improved the overall detection of malignant imaging features compared with EID CT, particularly at 0.4 mm. … Furthermore, PCCT significantly increased radiologists’ diagnostic confidence in lung cancer imaging features compared with EID CT, especially at 0.4 mm,” noted lead study author Yuhan Zhou, MMed, who is affiliated with the Department of Radiology at the First Affiliated Hospital of Zhengzhou University in Zhengzhou, China, and colleagues.
Three Key Takeaways
• Ultra-high-resolution PCCT (0.4 mm slices) substantially improves malignant feature detection in lung cancer compared with EID CT. In addition to higher detection of angiogram signs and vessel convergence/invasion with PCCT, the researchers also noted better detection of cases involving lobulation and bronchial stenosis.
• PCCT achieves these gains with markedly lower radiation and iodine load exposure. PCCT offered an approximately 66 percent lower effective radiation dose and approximately 27 percent lower iodine load than EID CT, which may reduce contrast-related adverse events and support safer longitudinal imaging.
• Improved image quality and reduced artifacts with PCCT increase diagnostic confidence. Researchers noted this was particularly the case for perivascular anatomy and mediastinal nodal assessment (e.g., stations 2R, 4R, prevascular), potentially enhancing nodal staging accuracy.
The researchers also noted a 66.34 percent reduction in effective radiation dosing with PCCT in comparison to EID-CT (1.36 mSv vs. 4.04 mSv) as well as a 26.57 percent reduction in iodine load (20.62 mg vs. 28.08 mg).
“In our study, the low-dose contrast media protocol decreased adverse reactions and the risk of contrast-induced acute kidney injury while reducing superior vena cava streak artifacts observed with PCCT, enhancing the delineation of perivascular lymph nodes and adjacent anatomic boundaries. This may translate to increased diagnostic confidence in nodal staging, particularly for stations 2R, 4R, and pre-vascular zone,” emphasized Zhou and colleagues.
(Editor’s note: For related content, see “Photon-Counting CT Facilitates 87 Percent Reduction in Radiation Dosing for Emphysema Assessment,” “Study Looks at Combining PCCT and Lung Texture Analysis for Evaluating ILD in Patients with Systemic Sclerosis” and “Computed Tomography: 2025 Year in Review.”)
Beyond the inherent limitations of a single-center study, the authors conceded potential bias due to the difficulty in ensuring the same image reconstruction parameters with PCCT and EID CT. The researchers also acknowledged differences in the clinical and imaging characteristics of tumors across patient groups and noted that the Chinese cohort may limit extrapolation of the study findings to broader populations.
