光子计数CT在头颈部放射学中的应用：连接探测器物理学与临床应用

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中文摘要

光子计数计算机断层扫描（PCCT）是头颈部成像的一项重大进步，相较于传统能量积分CT（EID-CT），它在技术和临床上均具有优势。这一革新主要基于五个技术方面：改善的空间分辨率、降低的图像噪声和金属伪影、更低的辐射暴露、减少的碘对比剂剂量以及光谱成像能力。在头颈部，增强的空间分辨率使得细小解剖结构（包括小血管、听小骨和软骨）的详细可视化成为可能，从而增强了术前规划和术后评估。噪声降低和金属伪影减轻有助于评估携带人工耳蜗、牙科硬件或术后材料的患者，使邻近软组织和骨骼的评估更加可靠。降低的辐射和对比剂剂量对儿科患者以及需要重复监测的个体尤其有价值，在保持诊断质量的同时将长期风险降至最低。最后，光谱成像，包括碘图、虚拟平扫和虚拟去钙重建，改善了组织表征，在头颈部区域从病变检测到颈动脉斑块表征的多种临床场景中可能有用。虽然每个技术特征具有独立价值，但在临床实践中，它们协同作用，使放射科医生能够增强病变检测、组织表征和整体诊断性能。随着临床经验的增长和证据的积累，PCCT有望成为全面、更安全、更精确评估头颈部病变（从常规头颈部成像到复杂的肿瘤学和治疗后随访研究）的重要工具。关键点：问题 具有最佳空间分辨率、降低的噪声和金属伪影以及光谱能力的光子计数CT能否改善复杂头颈部解剖结构的可视化？发现 技术进步转化为增强的病变检测、改善的组织表征以及对携带牙科硬件、植入物或术后材料的患者更可靠的评估。临床相关性 通过将物理创新与临床适用性相结合，光子计数CT提供了更安全、更精确的成像，具有更低的辐射和对比剂剂量，支持头颈部放射学诊断性能的改善。

英文摘要

Photon-counting computed tomography (PCCT) represents a significant advancement in head and neck imaging, offering both technical and clinical benefits over conventional energy-integrating CT (EID-CT). This revolution is mainly based on the five technical aspects: improved spatial resolution, reduced image noise and metal artifacts, lower radiation exposure, decreased iodinated contrast dose, and spectral imaging capabilities. In the head and neck, enhanced spatial resolution enables detailed visualization of fine anatomical structures, including small vessels, ossicles, and cartilage, thereby enhancing preoperative planning and postoperative assessment. Noise reduction and metal artifact mitigation facilitate the evaluation of patients with cochlear implants, dental hardware, or post-surgical materials, enabling more confident assessment of adjacent soft tissues and bone. Reduced radiation and contrast doses are particularly valuable in pediatric patients and in individuals requiring repeated surveillance, minimizing long-term risks while preserving diagnostic quality. Finally, spectral imaging, including iodine maps, virtual non-contrast, and virtual non-calcium reconstructions, improves tissue characterization, potentially useful in the head and neck region in several clinical scenarios ranging from lesion detection to carotid plaque characterization. While each technical feature has independent value, in clinical practice, they act synergistically, enabling radiologists to enhance lesion detection, tissue characterization, and overall diagnostic performance. As clinical experience grows and evidence accumulates, PCCT is poised to become an essential tool for comprehensive, safer, and more precise evaluation of head and neck pathologies, from routine head and neck imaging to complex oncologic and post-treatment follow-up studies. KEY POINTS: Question Can photon-counting CT, with optimal spatial resolution, reduced noise and metal artifacts, and spectral capabilities, improve the visualization of complex head and neck anatomy? Findings Technical advances translate into enhanced lesion detection, improved tissue characterization, and more confident assessment in patients with dental hardware, implants, or postoperative materials. Clinical relevance By combining physical innovations with clinical applicability, photon-counting CT offers safer, more precise imaging, with lower radiation and contrast doses, supporting improved diagnostic performance in head and neck radiology.