Clinical applications of photon-counting CT in abdominal oncologic imaging: a primer for developing a clinical practice

Photon-counting CT (PCCT) is an emerging imaging modality that offers improved spatial resolution, soft tissue contrast, material decomposition, and dose efficiency over conventional CT with energy-integrating detectors (EID-CT). For patients with abdominal malignancies, who routinely undergo cross-sectional imaging for diagnosis, staging, response assessment, and surveillance, PCCT has the potential to enhance the detection and characterization of contrast-enhanced tumors and improve treatment response assessment. The objectives of this review are to provide a comprehensive overview of the technical principles of PCCT, optimization strategies, advantages in abdominal oncologic imaging, and current clinical applications geared towards clinical radiologists. We also address implementation challenges and discuss future directions for integrating PCCT into routine oncologic care. As PCCT utilization increases, its impact on abdominal cancer diagnosis and management is expected to grow, offering new opportunities for precision medicine and personalized imaging strategies. Not applicable.