低剂量光子计数CT在放疗随访中的挑战与优势

Challenges and Advantages of Low-Dose Photon-Counting CT in Radiotherapy Follow-Up

摘要: 本文综述了低剂量光子计数CT在肿瘤放疗随访中的应用价值、当前挑战与未来前景。PCCT凭借其光子计数探测器的技术原理，实现了超高空间分辨率与多参数能谱成像，在显著降低辐射剂量的同时，为放疗随访中的关键临床难题提供了解决方案。这些优势具体体现在：有效抑制金属植入物相关伪影、提升放射性纤维化与肿瘤复发的鉴别能力、以及增强对亚毫米微小转移灶的早期探测灵敏度。然而，该技术仍面临探测器物理局限(如光子堆积效应)、新型伪影及算法优化等挑战。文献指出，当前临床证据仍以体模和单中心研究为主，未来需要通过多中心临床试验进一步验证其效能，并持续在探测器材料、自适应能谱成像和智能重建算法等领域进行创新，以充分发挥PCCT在精准放疗随访中的巨大潜力。

Abstract: This article reviews the application value, current challenges, and future prospects of low-dose photon-counting CT (PCCT) in tumor radiotherapy follow-up. Leveraging the technical principles of photon-counting detectors, PCCT achieves ultra-high spatial resolution and multi-parameter spectral imaging. While significantly reducing radiation dose, it provides solutions to key clinical challenges in radiotherapy follow-up. These advantages are specifically manifested in: effectively suppressing metal implant-related artifacts, improving the ability to differentiate between radiation-induced fibrosis and tumor recurrence, and enhancing early detection sensitivity for submillimeter metastatic lesions. However, the technology still faces challenges such as physical limitations of the detectors (e.g., pulse pile-up), novel artifacts, and the need for algorithm optimization. The literature indicates that current clinical evidence is still primarily based on phantom and single-center studies. Future work requires further validation of its efficacy through multicenter clinical trials, alongside ongoing innovation in areas such as detector materials, adaptive spectral imaging, and intelligent reconstruction algorithms to fully realize PCCT’s immense potential in precise radiotherapy follow-up.