CHỤP CẮT LỚP VI TÍNH ĐẾM PHOTON – NGUYÊN LÝ KỸ THUẬT, ƯU KHUYẾT ĐIỂM VÀ ỨNG DỤNG LÂM SÀNG
Nội dung chính của bài viết
Tóm tắt
Chụp cắt lớp vi tính đếm photon là một bước tiến mang tính cách mạng trong công nghệ chẩn đoán hình ảnh, dựa trên nguyên lý phát hiện và phân loại từng photon tia X thay vì tích hợp năng lượng như các hệ thống cắt lớp vi tính truyền thống. Bài tổng quan này nhằm trình bày toàn diện về nguyên lý kỹ thuật, ưu điểm, hạn chế và ứng dụng lâm sàng của cắt lớp vi tính đếm photon trong bối cảnh phát triển của hình ảnh học hiện đại. Về mặt kỹ thuật, cắt lớp vi tính đếm photon sử dụng đầu dò (detector) bán dẫn để chuyển đổi trực tiếp photon thành tín hiệu điện và phân loại theo các ngưỡng năng lượng, cho phép thực hiện chụp ảnh phổ liên tục và phân tích đặc hiệu vật liệu, bao gồm cả chụp ảnh bờ hấp thụ K (K-edge imaging). So với cắt lớp vi tính truyền thống và cắt lớp vi tính năng lượng kép, cắt lớp vi tính đếm photon có tiềm năng vượt trội về độ phân giải không gian, hiệu quả liều, giảm nhiễu và khả năng phân tích mô. Trong lâm sàng, cắt lớp vi tính đếm photon đã chứng minh giá trị trong nhiều lĩnh vực như tim mạch, hô hấp, thần kinh, cơ xương khớp và ung thư, đặc biệt trong đánh giá mảng xơ vữa thành mạch, tổn thương mô kẽ ở phổi và định lượng thuốc cản quang I-ốt (iodine). Tuy nhiên, chi phí cao, thách thức kỹ thuật và thiếu chuẩn hóa vẫn là những rào cản đáng kể. Trong tương lai, cắt lớp vi tính đếm photon được kỳ vọng đóng vai trò trung tâm trong hình ảnh học chính xác và cá thể hóa, đặc biệt khi kết hợp với trí tuệ nhân tạo và các thuốc cản quang đa thành phần.
Từ khóa
Cắt lớp vi tính đếm photon, đầu dò đếm photon, cắt lớp vi tính năng lượng kép
Chi tiết bài viết
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Tài liệu tham khảo
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7. D. Richtsmeier, C.A.S. Dunning, K. Iniewski and M. Bazalova-Carter. Multi-contrast K-edge imaging on a bench-top photon-counting CT system: acquisition parameter study. Journal of Instrumentation. 2020. 15(10), DOI:10.1088/1748-0221/15/10/P10029.
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10. Çağdaş Topel 1, Furkan Ufuk. Revolutionizing cardiac imaging: how photon-counting computed tomography is redefining coronary artery stent assessment. Diagn Interv Radiol. 2025. 31(4), 340-341, doi: 10.4274/dir.2025.253274.
11. Riccardo Cau, Luca Saba, Antonella Balestrieri, Antonella Meloni, Lorenzo Mannelli. PhotonCounting Computed Tomography in Atherosclerotic Plaque Characterization. Diagnostics (Basel). 2024.14(11), 1065, doi: 10.3390/diagnostics14111065.
12. Doosup Shin, Rick H J A Volleberg, Roosha Parikh, Christopher Chieh Yang Koo, Sarah Malik et al. Photon-counting detector computed tomography for the assessment of coronary stents and in-stent restenosis. EuroIntervention. 2025. 21(19), e1137-e1146, doi: 10.4244/EIJ-D-25-00257.
13. Giuseppe Tremamunno, Akos Varga-Szemes, Dmitrij Kravchenko, Andrea Laghi, Fabian Bamberg et al. Accuracy of photon-counting detector CT-based iodine maps for myocardial late enhancement detection. Eur Radiol. 2025. 35(11), 7074-7083, doi: 10.1007/s00330-025-11622-0. 14. Rafail A Kotronias, Betty Raman, Vanessa Ferreira, Stefan Neubauer, Charalambos Antoniades. Photon-counting computed tomography: 'one-stop shop' for coronary stenosis, inflammation, and myocardial assessment in ST-segment elevation acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2024. 25(6). e165, doi: 10.1093/ehjci/jeae003.
15. Wenbing Jiang, Yibin Pan, Yumeng Hu, Xiaochang Leng, Jun Jiang, et al. Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve. Biomed Eng Online. 2021. 20(1), 77, doi: 10.1186/s12938-021-00914-3.
16. Joel G Fletcher 1, Akitoshi Inoue 1, Alex Bratt 1, Kelly K Horst 1, Chi Wan Koo. Photoncounting CT in Thoracic Imaging: Early Clinical Evidence and Incorporation Into Clinical Practice. Radiology. 2024. 310(3), e231986, doi: 10.1148/radiol.231986.
17. Salim Aymeric Si-Mohamed, Jade Miailhes, Pierre-Antoine Rodesch, Sara Boccalini, Hugo Lacombe, et al. Spectral Photon-Counting CT Technology in Chest Imaging. J Clin Med. 2021. 10(24), 5757, doi: 10.3390/jcm10245757.
18. Felix K Kopp, Heiner Daerr, Salim Si-Mohamed, Andreas P Sauter, Sebastian Ehn, et al. Evaluation of a preclinical photon-counting CT prototype for pulmonary imaging. Sci Rep. 2018. 8(1), 17386, doi: 10.1038/s41598-018-35888-1.
19. Sarah C Scharm, Cornelia Schaefer-Prokop, Hinrich B Winther, Carolin Huisinga, Thomas Werncke, et al. Regional Pulmonary Morphology and Function: Photon-counting CT Assessment. Radiology. 2023. 308(1), e230318, doi: 10.1148/radiol.230318.
20. Arosh S Perera Molligoda Arachchige, Gabriel Amorim Moreira Alves, Daniil Fedorov, Gaia Ressa, Luca Cappellini, et al. Neuroimaging with photon-counting computed tomography: A review of clinical applications. World J Radiol. 2025. 17(11), 113701, doi:10.4329/wjr.v17.i11.113701.
21. Denise Schoenbeck, Alexander Sacha, Julius Henning Niehoff, Christoph Moenninghoff, Jan Borggrefe, et al. Imaging of intracranial hemorrhage in photon counting computed tomography using virtual monoenergetic images. Neuroradiology. 2024. 66(5), 729-736, doi: 10.1007/s00234-024-03308-z.
22. Fei Liu, Ying Yao, Bingcheng Zhu, Yue Yu, Reng Ren, et al. The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview. Front Med (Lausanne). 2024. 10(11), 1269742. doi: 10.3389/fmed.2024.1269742.
23. Chang-Lae Lee, Key Jo Hong, Namwoo Kim, Kwanhee Han, Dongkyu Kim, et al. Feasibility study of portable multi-energy computed tomography with photon-counting detector for preclinical and clinical applications. Sci Rep. 2021. 11(1), 22731, doi: 10.1038/s41598-021-02210-5.
24. Anna Novoseltseva, Gulce Kureli, Shuaibin Chang, Jiarui Yang, Precious Dominique Antinew, et al. Imaging myelin degradation in ex vivo prefrontal cortex tissue blocks in Alzheimer's disease and chronic traumatic encephalopathy. Alzheimers Dement. 2025. 21(8), e70582, doi:
10.1002/alz.70582.
25. Felix Sebastian Leo Thomsen, Sebastian Horstmeier, Julius Henning Niehoff, Jaime Andrés Peña, Jan Borggrefe. Effective Spatial Resolution of Photon Counting CT for Imaging of Trabecular Structures is Superior to Conventional Clinical CT and Similar to High Resolution Peripheral CT. Invest Radiol. 2022. 57(9), 620-626, doi: 10.1097/RLI.0000000000000873.
26. Charbel Mourad, Lucia Gallego Manzano, Anaïs Viry, Ronald Booij, Edwin H G Oei, et al. Chances and challenges of photon-counting CT in musculoskeletal imaging. Skeletal Radiol. 2024. 53(9), 1889-1902, doi: 10.1007/s00256-024-04622-6.
27. Elisa Bruno, Anna Palmisano, Enrico Camisassa, Davide Vignale, Carlo Tacchetti, et al. Photoncounting detector CT in oncology: a new era of cancer imaging. Insights Imaging. 2026. 17(1), 15, doi: 10.1186/s13244-025-02176-2.
28. Arosh S Perera Molligoda Arachchig, Anna Dashiell, Anton Shiraan Jesuraj, Antonia Immacolata D'Urso, Benedetta Fiore, et al. Applications of photon-counting CT in oncologic imaging: A systematic review. World J Radiol. 2025. 17(8), 107732, doi: 10.4329/wjr.v17.i8.107732.
29. Martin V Rybertt, Leening P Liu, Pooyan Sahbaee, Tristan Nowak, Manoj Mathew, et al. KEdge Imaging Using a Clinical Dual-Source Photon-Counting CT System. medRxiv. 2025. 08(21), 25333798, doi: 10.1101/2025.08.21.25333798.
30. Markus Benedikt Krueger, Thomas Werncke, Marcel Eicke, Nicolaus Schwerk, Jan Eckstein, et al. Photon-counting Detector CT Enables Pediatric Low-dose Chest Imaging With Further Reduction of Radiation Exposure. Invest Radiol. 2026. 61(5), 318-325, doi: 10.1097/RLI.0000000000001234.
31. Arosh S Perera Molligoda Arachchige, Yash Verma. Role of photon-counting computed tomography in pediatric cardiovascular imaging. World J Clin Pediatr. 2025. 14(1), 99288, doi: 10.5409/wjcp.v14.i1.99288.
2. Judith van der Bie, Thom van der Laan, Marcel van Straten, Ronald Booij, Daniel Bos et al. Photon-counting CT: An updated review of clinical results. European Journal of Radiology. 2025. 190, 112-189, https://doi.org/10.1016/j.ejrad.2025.112189
3. Yingyi Wu, Zheng Ye, Jie Chen, Liping Deng, Bin Song. Photon Counting CT: Technical Principles, Clinical Applications, and Future Prospects. Acad Radiol. 2023. 30(10), 362-2382, doi: 10.1016/j.acra.2023.05.029.
4. Megan C Jacobsen, Sara L Thrower, Rachel B Ger, Shuai Leng, Laurence E Court et al. Multienergy computed tomography and material quantification: Current barriers and opportunities for advancement. Med Phys. 2020. 47(8), 3752-3771. doi: 10.1002/mp.14241.
5. Chantelle Lachance, Jennifer Horton. Photon-Counting CT: High Resolution, Less Radiation: Emerging Health Technologies. Canadian Agency for Drugs and Technologies in Health. 2024.
6. Yuko Nakamura, Toru Higaki, Shota Kondo, Ikuo Kawashita, Isao Takahashi. An introduction to photon-counting detector CT (PCD CT) for radiologists. Jpn J Radiol. 2023. 41(3), 266-282. doi: 10.1007/s11604-022-01350-6.
7. D. Richtsmeier, C.A.S. Dunning, K. Iniewski and M. Bazalova-Carter. Multi-contrast K-edge imaging on a bench-top photon-counting CT system: acquisition parameter study. Journal of Instrumentation. 2020. 15(10), DOI:10.1088/1748-0221/15/10/P10029.
8. Ao Liu, Yixuan An, Zhi Kang Ng, Shuang Bai, Ruijun Wang. Clinical Advances and Challenges in Photon Counting CT: A State of the Art Review. Advances in Computed Tomography. 2025. 14(1), 1-11, DOI: 10.4236/act.2025.141001.
9. Yannik Christian Layer, Dmitrij Kravchenko, Tatjana Dell, Daniel Kütting. CT technology: photon-counting detector computed tomography. Radiologie (Heidelb). 2023. 63(7), 497-506, doi: 10.1007/s00117-023-01166-z.
10. Çağdaş Topel 1, Furkan Ufuk. Revolutionizing cardiac imaging: how photon-counting computed tomography is redefining coronary artery stent assessment. Diagn Interv Radiol. 2025. 31(4), 340-341, doi: 10.4274/dir.2025.253274.
11. Riccardo Cau, Luca Saba, Antonella Balestrieri, Antonella Meloni, Lorenzo Mannelli. PhotonCounting Computed Tomography in Atherosclerotic Plaque Characterization. Diagnostics (Basel). 2024.14(11), 1065, doi: 10.3390/diagnostics14111065.
12. Doosup Shin, Rick H J A Volleberg, Roosha Parikh, Christopher Chieh Yang Koo, Sarah Malik et al. Photon-counting detector computed tomography for the assessment of coronary stents and in-stent restenosis. EuroIntervention. 2025. 21(19), e1137-e1146, doi: 10.4244/EIJ-D-25-00257.
13. Giuseppe Tremamunno, Akos Varga-Szemes, Dmitrij Kravchenko, Andrea Laghi, Fabian Bamberg et al. Accuracy of photon-counting detector CT-based iodine maps for myocardial late enhancement detection. Eur Radiol. 2025. 35(11), 7074-7083, doi: 10.1007/s00330-025-11622-0. 14. Rafail A Kotronias, Betty Raman, Vanessa Ferreira, Stefan Neubauer, Charalambos Antoniades. Photon-counting computed tomography: 'one-stop shop' for coronary stenosis, inflammation, and myocardial assessment in ST-segment elevation acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2024. 25(6). e165, doi: 10.1093/ehjci/jeae003.
15. Wenbing Jiang, Yibin Pan, Yumeng Hu, Xiaochang Leng, Jun Jiang, et al. Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve. Biomed Eng Online. 2021. 20(1), 77, doi: 10.1186/s12938-021-00914-3.
16. Joel G Fletcher 1, Akitoshi Inoue 1, Alex Bratt 1, Kelly K Horst 1, Chi Wan Koo. Photoncounting CT in Thoracic Imaging: Early Clinical Evidence and Incorporation Into Clinical Practice. Radiology. 2024. 310(3), e231986, doi: 10.1148/radiol.231986.
17. Salim Aymeric Si-Mohamed, Jade Miailhes, Pierre-Antoine Rodesch, Sara Boccalini, Hugo Lacombe, et al. Spectral Photon-Counting CT Technology in Chest Imaging. J Clin Med. 2021. 10(24), 5757, doi: 10.3390/jcm10245757.
18. Felix K Kopp, Heiner Daerr, Salim Si-Mohamed, Andreas P Sauter, Sebastian Ehn, et al. Evaluation of a preclinical photon-counting CT prototype for pulmonary imaging. Sci Rep. 2018. 8(1), 17386, doi: 10.1038/s41598-018-35888-1.
19. Sarah C Scharm, Cornelia Schaefer-Prokop, Hinrich B Winther, Carolin Huisinga, Thomas Werncke, et al. Regional Pulmonary Morphology and Function: Photon-counting CT Assessment. Radiology. 2023. 308(1), e230318, doi: 10.1148/radiol.230318.
20. Arosh S Perera Molligoda Arachchige, Gabriel Amorim Moreira Alves, Daniil Fedorov, Gaia Ressa, Luca Cappellini, et al. Neuroimaging with photon-counting computed tomography: A review of clinical applications. World J Radiol. 2025. 17(11), 113701, doi:10.4329/wjr.v17.i11.113701.
21. Denise Schoenbeck, Alexander Sacha, Julius Henning Niehoff, Christoph Moenninghoff, Jan Borggrefe, et al. Imaging of intracranial hemorrhage in photon counting computed tomography using virtual monoenergetic images. Neuroradiology. 2024. 66(5), 729-736, doi: 10.1007/s00234-024-03308-z.
22. Fei Liu, Ying Yao, Bingcheng Zhu, Yue Yu, Reng Ren, et al. The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview. Front Med (Lausanne). 2024. 10(11), 1269742. doi: 10.3389/fmed.2024.1269742.
23. Chang-Lae Lee, Key Jo Hong, Namwoo Kim, Kwanhee Han, Dongkyu Kim, et al. Feasibility study of portable multi-energy computed tomography with photon-counting detector for preclinical and clinical applications. Sci Rep. 2021. 11(1), 22731, doi: 10.1038/s41598-021-02210-5.
24. Anna Novoseltseva, Gulce Kureli, Shuaibin Chang, Jiarui Yang, Precious Dominique Antinew, et al. Imaging myelin degradation in ex vivo prefrontal cortex tissue blocks in Alzheimer's disease and chronic traumatic encephalopathy. Alzheimers Dement. 2025. 21(8), e70582, doi:
10.1002/alz.70582.
25. Felix Sebastian Leo Thomsen, Sebastian Horstmeier, Julius Henning Niehoff, Jaime Andrés Peña, Jan Borggrefe. Effective Spatial Resolution of Photon Counting CT for Imaging of Trabecular Structures is Superior to Conventional Clinical CT and Similar to High Resolution Peripheral CT. Invest Radiol. 2022. 57(9), 620-626, doi: 10.1097/RLI.0000000000000873.
26. Charbel Mourad, Lucia Gallego Manzano, Anaïs Viry, Ronald Booij, Edwin H G Oei, et al. Chances and challenges of photon-counting CT in musculoskeletal imaging. Skeletal Radiol. 2024. 53(9), 1889-1902, doi: 10.1007/s00256-024-04622-6.
27. Elisa Bruno, Anna Palmisano, Enrico Camisassa, Davide Vignale, Carlo Tacchetti, et al. Photoncounting detector CT in oncology: a new era of cancer imaging. Insights Imaging. 2026. 17(1), 15, doi: 10.1186/s13244-025-02176-2.
28. Arosh S Perera Molligoda Arachchig, Anna Dashiell, Anton Shiraan Jesuraj, Antonia Immacolata D'Urso, Benedetta Fiore, et al. Applications of photon-counting CT in oncologic imaging: A systematic review. World J Radiol. 2025. 17(8), 107732, doi: 10.4329/wjr.v17.i8.107732.
29. Martin V Rybertt, Leening P Liu, Pooyan Sahbaee, Tristan Nowak, Manoj Mathew, et al. KEdge Imaging Using a Clinical Dual-Source Photon-Counting CT System. medRxiv. 2025. 08(21), 25333798, doi: 10.1101/2025.08.21.25333798.
30. Markus Benedikt Krueger, Thomas Werncke, Marcel Eicke, Nicolaus Schwerk, Jan Eckstein, et al. Photon-counting Detector CT Enables Pediatric Low-dose Chest Imaging With Further Reduction of Radiation Exposure. Invest Radiol. 2026. 61(5), 318-325, doi: 10.1097/RLI.0000000000001234.
31. Arosh S Perera Molligoda Arachchige, Yash Verma. Role of photon-counting computed tomography in pediatric cardiovascular imaging. World J Clin Pediatr. 2025. 14(1), 99288, doi: 10.5409/wjcp.v14.i1.99288.