光子计数计算机断层扫描（photon-counting computed tomography， PCCT）作为新一代CT成像技术，通过光子探测器单光子逐一探测与能量分辨能力，实现了成像质量的显著提升，及辐射剂量、图像噪声的有效降低。目前，PCCT在神经系统成像领域有广阔的临床应用前景，尤其在颅内精细结构显示、颅内动脉瘤诊断和治疗监测、颅内动脉狭窄及脊髓血管病变诊疗中展现出了独特优势。头颈动脉PCCT超高分辨率（ultra-high-resolution， UHR）模式（层厚0.2 mm），在BV64~BV72卷积核重建中具有较高的信噪比；对照数字减影血管造影（digital subtraction angiography， DSA）金标准，UHR-PCCT血管成像（UHR-PCCTA）在诊断颅内动脉小动脉瘤方面的灵敏度、特异度、准确率和评估者间一致性分别约为98.0%、96.7%、97.3%和0.95（Kappa值）。此外，UHR-PCCT对动脉瘤不规则性、动脉瘤壁及其瘤内特征的识别均显著优于传统能量积分型探测器CT（energy-integrating detector CT， EID-CT）。采用UHR-PCCT有望对动脉狭窄程度进行精准评估，甚至能达到接近DSA的效果，借助其多能级虚拟单能量重建，还有望实现对颅内动脉粥样硬化斑块的定量分析和对斑块破裂风险的预测。在锐利重建核（BV72~BV80）下，PCCT对颅内动脉植入支架状态及残余动脉瘤显示清晰，为颅内动脉治疗术后替代DSA的无创监测提供新方法。PCCT在神经系统成像中的多元化应用，将为其更好地在神经系统疾病诊治中发挥作用奠定基础。然而，目前PCCT在神经系统领域的广泛应用仍受限于设备普及度、特定场景（如微小穿支动脉、重度钙化/金属植入物）下的成像优化需求以及缺乏大规模临床验证数据的支持。未来需通过硬件迭代升级、算法优化改进及多中心前瞻性研究的推动，逐步克服这些限制，充分释放PCCT的临床潜力。

Photon-counting computed tomography (PCCT) is a next-generation CT imaging technology that markedly improves image quality while reducing radiation dose and image noise through single-photon detection and energy discrimination by photon detectors. At present, PCCT holds broad clinical application prospects in the field of neuroimaging, especially demonstrating unique advantages in the visualization of fine intracranial structures, the diagnosis and treatment monitoring of intracranial aneurysms, and the diagnosis and treatment of intracranial artery stenosis and spinal vascular lesions. In ultra-high-resolution (UHR) mode (slice thickness of 0.2 mm), PCCT of the head and neck arteries achieves high signal-to-noise ratios using BV64-BV72 convolution kernel reconstruction. With the digital subtraction angiography (DSA) as the gold standard, UHR-PCCTA shows sensitivity, specificity, accuracy, and inter-rater agreement of approximately 98.0%, 96.7%, 97.3%, and 0.95 (Kappa values), respectively, in diagnosing small intracranial aneurysms. In addition, UHR-PCCT significantly outperforms conventional energy-integrating detector CT (EID-CT) in identifying aneurysm irregularity, aneurysm wall, and intraluminal features. UHR-PCCT is expected to enable precise evaluation of the degree of arterial stenosis, potentially approaching the accuracy of DSA. With its multi-energy virtual monoenergetic reconstructions, it shows promise for quantitative analysis of intracranial athe-rosclerotic plaques and prediction of plaque rupture risk. Under sharp reconstruction kernels (e.g., BV72-BV80), PCCT enables clear visualization of intracranial arterial stents and residual aneurysms, offering a new noninvasive alternative to DSA for postope-rative monitoring of intracranial artery treatments. The diversified applications of PCCT in neuroimaging will lay a foundation for its better role in the diagnosis and treatment of neurological diseases. However, the widespread application of PCCT in the neurological field remains limited by factors such as restricted equipment availability, the need for imaging optimization in specific scenarios (e.g., small perforating arteries, severe calcifications, or metallic implants), and the lack of support from large-scale clinical validation data. In the future, it is necessary to gradually overcome these limitations through continued hardware upgrades, algorithmic optimization, and the advancement of multicenter prospective studies to fully unleash the clinical potential of PCCT.