Pulmonary nodule image quality and morphologic visualization with photon-counting detector CT: a scoping review

European Radiology Cardiovascular and Thoracic, vol. 1

Abstract

Abstract Objective To systematically map the available evidence on pulmonary nodule visualization quality using photon-counting CT (PCD-CT). Materials and methods This scoping review followed JBI methodology and PRISMA-ScR reporting standards. MEDLINE/PubMed, Embase, and Scopus were searched from January 2021 to January 2026. Studies evaluating pulmonary nodule visualization in adults or ex vivo human specimens using PCD-CT were included. Two reviewers independently screened records and extracted data; consistent with scoping review methodology, no formal risk-of-bias assessment was performed. Results Five studies (six records; 318 patients, mean age range 56–69 years) and 20 cadaveric lungs met the inclusion criteria. All studies used the same PCD-CT platform. Image quality: same-day comparisons showed superior subjective image quality with PCD-CT at 12%–18% lower radiation doses ( p < 0.001). Morphologic feature visualization: PCD-CT detected additional features in 34%–73% of subsolid nodules; ex vivo histological correlation demonstrated higher morphological concordance at 1024-matrix resolution. Nodule detection: ultra-low-dose PCD-CT maintained detection sensitivity of 0.94. Conclusion PCD-CT shows promise for improving pulmonary nodule visualization at reduced radiation doses. Evidence remains limited to single-center studies without clinical outcome validation, precluding implementation recommendations. Key Points Question Whether photon-counting detector CT improves image quality and morphologic characterization of pulmonary nodules compared with energy-integrating detector CT remains insufficiently mapped. Findings Photon-counting detector CT showed superior subjective image quality, additional morphologic features in 34%–73% of subsolid nodules, and 12%–18% lower doses versus energy-integrating detector CT. Relevance statement In single-center studies, photon-counting detector CT improved morphologic characterization of pulmonary nodules and reduced radiation exposure; clinical outcome validation is required before broad implementation.

Authors 7

1. Felix Barajas Ordonez corresponding Aachen Department of Diagnostic and Interventional Radiology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

2. Isaac Eli Martinez Safar

   Universidad Libre de Barranquilla

   Affiliation as printed

   School of Medicine, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia

3. Ana M Rendón-Garavito

   Pontificia Universidad Javeriana

   Affiliation as printed

   Department of Radiology and Diagnostic Imaging, Faculty of Medicine, Pontificia Universidad Javeriana, Cra 7° #40-62, Bogotá, Colombia

4. Can Yüksel Aachen Department of Diagnostic and Interventional Radiology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

5. Christiane Katharina Kuhl Aachen Department of Diagnostic and Interventional Radiology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

6. Omar Andrés Pantoja Burbano

   Pontificia Universidad Javeriana

   Affiliation as printed

   Department of Radiology and Diagnostic Imaging, Faculty of Medicine, Pontificia Universidad Javeriana, Cra 7° #40-62, Bogotá, Colombia

7. Felipe Aluja Jaramillo

   Pontificia Universidad Javeriana

   Affiliation as printed

   Department of Radiology and Diagnostic Imaging, Faculty of Medicine, Pontificia Universidad Javeriana, Cra 7° #40-62, Bogotá, Colombia