A combined positron emission particle tracking (PEPT) and X-ray computed tomography (CT) technique is presented, and its utility is demonstrated through investigation of flow in a pipe with twisted tape swirl insert with varying flow conditions (diameter-based Reynolds numbers 16,300–63,300). A description of this technique is given, as well as data handling practices used to relate geometric information captured by CT to fluid flow data gathered via PEPT. It is found that the CT component is readily capable of capturing the stainless steel insert geometry in this present system, but the use of combined plastic and metal materials leads to artifacts in imaging of the plastic surface. Nonetheless, CT data are related to PEPT flow measurements, and average velocity fields are calculated via a pseudo-framing and interpolation scheme and used to visualize and interrogate key flow phenomena within the system. Radial velocity profiles of the mean flow characteristics are seen to collapse to a nearly common form across all flow conditions considered. Helical vortices are seen propagating through the flow field, generated by bypass flow around the gap between the insert and pipe wall, with additional coherent secondary flow structures seen in the higher Reynolds number cases. These findings enhance the understanding of the mixing mechanisms in these swirl flows and encourage the continued development of PEPT-CT methodologies for 3D flow measurements in optically inaccessible systems.