X-ray detection has a wide application in critical fields such as medical diagnostics, security screening, industrial non-destructive testing, and environmental monitoring. Metal halide perovskite single crystals have emerged as promising candidates for developing low-cost, high-performance X-ray detection systems due to their compositional tunability, strong X-ray attenuation coefficients, high carrier mobility-lifetime product, and low-temperature solution-processable growth. This review focuses on the crystal structure dimensional regulation of metal halide perovskite single crystal and their effect on X-ray detection performance,and summarizing recent advances in perovskite single crystal-based direct X-ray detectors. Through a detailed analysis of crystal growth methods, semiconductor properties, and X-ray detection performance across perovskites with various dimensionalities, this review unveils the intrinsic relationship between crystal structural dimensionality and photoelectronic detection capabilities. Based on these discussions, challenges currently faced by perovskite single crystal X-ray detectors are critically examined. Future research directions are proposed to guide the design and growth of large-size high-quality perovskite single crystals and the realization of stable, high-sensitivity X-ray detection systems. This review provides both theoretical insights and practical guidelines for advancing perovskite-based X-ray detection technologies toward practical applications.