BackgroundCardiovascular CT is required for planning of transcatheter aortic valve implantation (TAVI). PurposeTo compare image quality, suitability for TAVI planning, and radiation dose of photon-counting CT (PCCT) with that of dual-source CT (DSCT). Material and MethodsRetrospective study on consecutive TAVI candidates with aortic valve stenosis who underwent contrast-enhanced aorto-ilio-femoral PCCT and/or DSCT between 01/2022–07/2023. Signal-to-noise (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized ROI-analysis. Image quality and suitability for TAVI planning were assessed by four independent expert readers (two cardiac radiologists, two cardiologists) on a 5-point-scale. CT dose-index (CTDI) and dose-length-product (DLP) were used to calculate effective radiation dose (eRD). Results300 patients (136 female, median age: 81 years, IQR: 76-84) underwent 302 CT-examinations, with PCCT in 202, DSCT in 100; two patients underwent both. Although SNR and CNR were significantly lower in PCCT vs. DSCT-images (33.0±10.5 vs. 47.3±16.4 and 47.3±14.8 vs. 59.3±21.9, P<.001, respectively), visual image quality was higher in PCCT vs. DSCT (4.8 vs. 3.3, P <.001), with moderate overall inter-reader agreement among radiologists and among cardiologists (κ=0.60, respectively). Image quality was rated as “excellent” in 160/202 (79.2%) of PCCT vs. 5/100 (5%) of DSCT-cases. Readers found images suitable to depict the aortic valve hinge-points and to map the femoral access path in 99% of PCCT vs. 85% of DSCT (P<0.01), with suitability ranked significantly higher in PCCT vs. DSCT (4.8 vs. 3.3, P<.001). Mean CTDI and DLP, and thus eRD, were significantly lower for PCCT vs. DSCT (22.4 vs. 62.9; 519.4 vs. 895.5, and 8.8 ± 4.5 mSv vs. 15.3 ± 5.8 mSv; all P<.001). ConclusionPCCT improves image quality, effectively avoids non-diagnostic CT-imaging for TAVI planning, and is associated with a lower radiation dose compared with state-of-the-art DSCT. Radiologists and cardiologists found PCCT images more suitable for TAVI planning.