What To Expect (and What Not) From Dual-energy CT Imaging Now and in the Future?

Abstract

Dual-energy CT (DECT) imaging has broadened the potential of CT imaging by offering multiple postprocessing datasets with a single acquisition at more than one energy level. DECT shows profound capabilities to improve diagnosis based on its superior material differentiation and its quantitative value. However, the potential of dual energy imaging remains relatively untapped, possibly due to its intricate workflow and intrinsic technical limitations of DECT. Knowing the clinical advantages of dual-energy imaging and recognizing its limitations and pitfalls is neces-sary for an appropriate clinical use. The aims of this paper are to review physical and technical basis of DECT acquisition and analysis, to discuss advantages and limitations of DECT in dif-ferent clinical scenarios, to review technical constraints in material labeling and quantification, and to evaluate cutting-edge applications of DECT imaging, including artificial intelligence, qualitative and quantitative imaging biomarkers, and DECT-derived radiomics and radioge-nomics