Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment is essential throughout the perioperative period. This narrative review outlines the clinical potential of PCCT in surgical planning, intra- and postoperative evaluation, and follow-up of both oncologic and non-oncologic thoracic conditions. PCCT enables accurate bronchovascular mapping and iodine-based perfusion imaging, supporting sublobar resection planning and risk stratification in patients with complex anatomy or reduced lung function. Postoperatively, it enhances detection of subtle complications—such as air leaks or hematomas—and improves image quality near metallic implants through advanced artifact reduction techniques. The ability to combine high-resolution imaging with functional data allows for comprehensive evaluation in a single scan and may aid in differentiating fibrosis from local recurrence. Despite its promises, PCCT adoption is currently limited by high cost, restricted availability, and the need for training and system integration. Furthermore, prospective clinical studies are still needed to determine its impact on surgical outcomes. As technological and infrastructural challenges are addressed, PCCT may become a valuable component of image-guided thoracic surgery, contributing to safer, more personalized care.
光子计数计算机断层扫描（PCCT）凭借其超高空间分辨率、更低噪声、能谱成像能力以及相较于传统CT更低的辐射剂量，为胸部影像学开启了新纪元。这些特性在胸外科领域尤为重要，因为围手术期需要精确的解剖和功能评估。本文综述概述了PCCT在肿瘤性和非肿瘤性胸部疾病的手术规划、术中术后评估及随访中的临床应用潜力。PCCT能够实现精确的支气管血管成像和基于碘的灌注成像，为解剖结构复杂或肺功能减退患者的亚肺叶切除规划和风险分层提供支持。术后，它通过先进的伪影抑制技术，提高了对细微并发症（如漏气或血肿）的检出率，并改善了金属植入物附近的图像质量。将高分辨率成像与功能数据相结合的能力，使得单次扫描即可进行全面评估，并有助于区分纤维化与局部复发。尽管前景广阔，但PCCT目前的应用仍受限于高昂成本、设备普及度不足以及培训与系统整合的需求。此外，仍需前瞻性临床研究来确定其对手术结局的影响。随着技术和基础设施挑战的逐步解决，PCCT有望成为影像引导胸外科手术的重要组成部分，为更安全、更个性化的诊疗提供支持。
肿瘤(癌症)患者之家