A review of current applications of photon-counting CT in musculoskeletal imaging

• Photon-counting CT is a breakthrough technology for musculoskeletal imaging, providing ultra-high spatial resolution, reduced noise and artifacts, and always-available spectral information, resulting in detailed anatomic assessment and advanced tissue characterization of bone, bone marrow, and soft tissues. • For each musculoskeletal condition, photon-counting CT holds the promise of actual diagnostic improvements because it allows for better detection of subtle fractures, earlier and more accurate recognition of infectious, inflammatory, and neoplastic bone diseases, and improved assessment of metallic implants and their environment. • Although photon-counting CT opens new avenues, technical and clinical challenges remain, including larger data volumes and costs. Photon-counting computed tomography (PCCT) is a significant technological advancement in musculoskeletal imaging. Unlike traditional CT detectors, which are energy-integrating detectors, PCCT uses direct-conversion technology, or photon-counting detectors. This enables ultra-high spatial resolution, systematic spectral imaging, and effective electronic noise reduction without increasing radiation exposure. This review article illustrates the potential benefit of PCCT in clinical practice across a broad spectrum of musculoskeletal disorders. PCCT is expected to improve the detection and characterization of fractures, infections, inflammatory and degenerative arthropathies, bone marrow disorders, tumors, congenital bone diseases, and postoperative complications. It will also assist with interventional procedures. PCCT holds great promise for opportunistic imaging and artificial intelligence-driven analytics in musculoskeletal radiology.