It was only fitting that when computed tomography (CT) was celebrating its 50th birthday
since its maiden scan in 1971, it was also entering into a new generation in 2021
with the Food and Drug Administration's approval of the first photon-counting detector
(PCD)-CT. As non-invasive cardiac imaging is evolving into an ever more important
medical field, the introduction of this new technology promises a slew of improvements
over energy-integrating detector (EID)-CTs, most importantly improved spatial resolution
in the form of ultrahigh-resolution (UHR) imaging, reduced radiation exposure, and
routinely acquired spectral information. Spatial resolution has historically been
a key hurdle for cardiac CT, especially for coronary imaging where structures in the
realm of 2 mm need to be assessed. Initial reports on the use of PCD-CT in cardiac
imaging so far have been promising, but many questions ranging from standardized scan
protocols to evidence-based recommendations remain. The aim of this review is to discuss
the currently available literature regarding the use of UHR PCD-CT for cardiac imaging
and explore if it has led to changes in guidelines or patient workflows.
