ABSTRACT Pericardial metastases are common in advanced cancers but often remain undetected due to subtle symptoms. Photon‐counting CT ( PCT ) offers improved spatial resolution and contrast‐to‐noise ratio ( CNR ) compared with conventional CT ( CCT ), potentially enhancing diagnostic performance. In this retrospective single‐center study, patients diagnosed with pericardial metastases by transthoracic echocardiography (TTE) between April and September 2025, who underwent both unenhanced and contrast‐enhanced chest CT were included. After Propensity Score Matching (PSM), two groups were established: the PCT group ( n = 11; reconstructions at 0.4 and 1 mm) and the CCT group ( n = 22). Diagnostic sensitivity, image quality, and radiation dose were assessed, with TTE as the reference standard. PCT‐0.4 mm demonstrated the highest overall sensitivity (91.5%) and small‐lesion sensitivity (88.9%), followed by PCT‐1 mm (87.2% and 83.3%) and CCT‐1 mm (86.1% and 78.6%). Although not statistically significant, PCT showed consistently better lesion detection. The PCT‐0.4 mm group showed higher standardized CNR versus CCT‐1 mm (Tukey–Kramer p = 0.021) but not versus PCT‐1 mm ( p = 0.641); overall one‐way ANOVA p = 0.020, whereas SNR did not differ among groups (ANOVA p = 0.18). Radiation exposure was significantly lower with PCT than CCT (ED: 11.7 ± 3.9 vs. 20.6 ± 6.6 mSv; p < 0.001). Compared with the 1‐mm CCT reconstruction, the 0.4‐mm PCT showed a trend toward improved detection of both overall and small pericardial metastases, enhanced image quality, and reduced radiation dose, highlighting its potential clinical value in managing pericardial metastases.
Wang et al. (Mon,) studied this question.