Photon-Counting Detector CT for Musculoskeletal Imaging: A Clinical Perspective

Research output: Contribution to journalArticlepeer-review


Photon-counting detector (PCD) CT has emerged as a novel imaging modality that represents a fundamental shift in the way that CT systems detect x-rays. After preclinical and clinical investigations showed benefits of PCD CT for a range of imaging tasks, the U.S. FDA in 2021 approved the first commercial PCD CT system for clinical use. The technologic features of PCD CT are particularly well suited for musculoskeletal imaging applications. Advantages of PCD CT compared with conventional energy-integrating detector (EID) CT include smaller detector pixels and excellent geometric dose efficiency that enable imaging of large joints and central skeletal anatomy at ultrahigh spatial resolution; advanced multienergy spectral postprocessing that allows quantification of gout deposits and generation of virtual noncalcium images for visualization of bone edema; improved metal artifact reduction for imaging of orthopedic implants; and higher CNR and suppression of electronic noise. Given substantially improved cortical and trabecular detail, PCD CT images more clearly depict skeletal abnormalities, including fractures, lytic lesions, and mineralized tumor matrix. The purpose of this article is to review, by use of clinical examples comparing EID CT and PCD CT, the technical features of PCD CT and their associated impact on musculoskeletal imaging applications.

Original languageEnglish (US)
Pages (from-to)551-561
Number of pages11
JournalAmerican Journal of Roentgenology
Issue number4
StatePublished - Apr 2023


  • CT
  • artifacts
  • diagnostic imaging
  • image enhancement
  • joint diseases
  • musculoskeletal system
  • x-ray

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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