PHOTON-COUNTING COMPUTED TOMOGRAPHY IN PERIOPERATIVE IMAGING AND ANESTHESIOLOGY: A SYSTEMATIC REVIEW

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0887

Abstract

Introduction: Photon-counting computed tomography (PCCT) represents an evolution of conventional CT by detecting individual photons, discriminating energy thresholds, and reducing electronic noise. These features enable higher spatial resolution, intrinsic spectral imaging, and potential optimization of radiation dose and iodinated contrast volume. In anesthesiology, its value may extend beyond radiological diagnosis by supporting preoperative assessment, airway planning, cardiopulmonary risk stratification, and safety in complex surgical patients.1,6,7 Objective: To systematically synthesize the clinical evidence on PCCT applications in perioperative imaging and anesthesiology, with emphasis on airway assessment, thoracic and cardiovascular imaging, obesity, contrast exposure, and high-risk surgical scenarios. Methods: A systematic literature review was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library from January 2010 to May 2026 using terms related to photon-counting CT, photon-counting detector CT, spectral CT, perioperative imaging, preoperative assessment, airway, thoracic imaging, cardiovascular imaging, and anesthesia. PRISMA 2020 recommendations were followed. Human clinical studies, systematic or scoping reviews, and methodologically explicit narrative reviews reporting PCCT clinical applications with diagnostic or perioperative relevance were included. Results: Fifteen clinical or synthesis publications on PCCT were included, and anesthesiology references were integrated to contextualize perioperative implications. The most relevant perioperative applications were coronary and vascular angiography, high-resolution thoracic imaging, characterization of nodules and interstitial lung disease, dose reduction in serial imaging, contrast optimization in patients at renal risk, and improved image quality in obese patients. Direct evidence in anesthesiology remains limited; most benefits are inferred from radiological, surgical, and cardiovascular studies. Conclusions: PCCT is a promising technology for integrating advanced imaging into perioperative decision-making. Its anesthesiology-related potential is focused on anticipating complex airways, cardiopulmonary assessment, thoracic and oncologic surgical planning, and reducing radiation or contrast exposure in vulnerable patients. Prospective studies centered on anesthetic outcomes are required to define its impact on perioperative complications, clinical decision-making, and cost-effectiveness.

Keywords: computed tomography; photon counting; perioperative imaging; anesthesiology; airway; preoperative assessment.