Perera Molligoda Arachchige AS, Alves GAM, Fedorov D, Ressa G, Cappellini L, Levi R, Savini G, Catapano F, Francone M, Politi LS. Neuroimaging with photon-counting computed tomography: A review of clinical applications. World J Radiol 2025; 17(11): 113701 [DOI: 10.4329/wjr.v17.i11.113701]
Corresponding Author of This Article
Arosh S Perera Molligoda Arachchige, MD, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele 20072, Milan, Italy. aroshshavinda.pereramolligodaarachchige@st.hunimed.eu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Nov 28, 2025; 17(11): 113701 Published online Nov 28, 2025. doi: 10.4329/wjr.v17.i11.113701
Neuroimaging with photon-counting computed tomography: A review of clinical applications
Arosh S Perera Molligoda Arachchige, Gabriel Amorim Moreira Alves, Daniil Fedorov, Gaia Ressa, Luca Cappellini, Riccardo Levi, Giovanni Savini, Federica Catapano, Marco Francone, Letterio S Politi
Arosh S Perera Molligoda Arachchige, Gabriel Amorim Moreira Alves, Daniil Fedorov, Luca Cappellini, Federica Catapano, Marco Francone, Letterio S Politi, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Milan, Italy
Gaia Ressa, Riccardo Levi, Giovanni Savini, Marco Francone, Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano 20089, Lombardy, Italy
Letterio S Politi, Department of Neuroradiology, IRCCS Humanitas Research Hospital, Rozzano 20089, Lombardy, Italy
Author contributions: Perera Molligoda Arachchige AS conceived, designed, and planned the review; Politi LS and Perera Molligoda Arachchige AS prepared and curated the figures; all authors contributed equally to the literature review, critical discussion, and revision of the manuscript draft written by Perera Molligoda Arachchige AS. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arosh S Perera Molligoda Arachchige, MD, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele 20072, Milan, Italy. aroshshavinda.pereramolligodaarachchige@st.hunimed.eu
Received: September 1, 2025 Revised: October 11, 2025 Accepted: October 28, 2025 Published online: November 28, 2025 Processing time: 87 Days and 11.2 Hours
Abstract
Photon-counting computed tomography (PCCT) represents a transformative advancement in neuroimaging, offering superior spatial resolution, spectral imaging capabilities, reduced radiation dose, and enhanced contrast-to-noise ratios. This review explores the technical foundations of PCCT, its advantages over conventional CT, and its growing applications in neuroimaging. PCCT has shown promise in improving neurovascular imaging, detecting small vessels, and reducing artifacts near metallic implants. It also enhances the visualization of spontaneous intracranial hypotension and cerebrospinal fluid leaks and provides superior diagnostic accuracy in acute ischemic stroke imaging. However, current limitations, including protocol complexity, high data volume, and the absence of integrated artificial intelligence noise reduction algorithms, pose challenges to widespread adoption. Future research should address these limitations and refine PCCT’s applications to unlock its full clinical potential.
Core Tip: Photon-counting computed tomography offers unprecedented spatial and spectral resolution in neuroimaging, enabling improved detection of subtle pathologies such as small vessels, cerebrospinal fluid leaks, and early ischemic changes, while reducing artifacts and radiation dose. Despite current challenges in protocol standardization, data handling, and integration of artificial intelligence-based noise reduction, photon-counting computed tomography holds strong potential to become a new standard in clinical neuroimaging.
