Clinical abdominal dual-energy CT: 15 years later

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

“…DECT, which is based on simultaneously acquisition of two datasets at different energy levels, has the potential to generate virtual monochromatic images (VMIs). These images have higher contrast at lower energy levels because they use an approximation of energy levels closer to the k-edge of iodine at 33 keV [ 59 ]. Yoon et al showed that low monoenergetic images (50 keV) allowed significantly better focal liver lesion conspicuity even after lowering both radiation and contrast media doses by 30%, compared with standard-dose in non obese patients [ 58 ].…”

“…Newer techniques have been introduced to increase lesion detection and characterization, such as dual-energy CT (DECT) with low-energy acquisition at 80 kVp instead of the frequently applied 120 kVp [45,[50][51][52][53][54][55][56][57][58][59]. DECT, which is based on simultaneously acquisition of two datasets at different energy levels, has the potential to generate virtual monochromatic images (VMIs).…”

“…Patients with a suspicion of HCC or a history of HCC belong to this category owing to the demand for an intense follow-up strategy due to the high risk of HCC recurrence. However, radiation exposure is often underestimated in oncologic patients due to their relatively short life expectancy and the clinicians' focus on the immense benefit of early detection of recurrence [58][59][60][61]. Indeed, patients with very early or earlystage HCCs who have a life expectancy of longer than 5 years, usually undergo multiple CT scans at 3-to 4month intervals so as to detect recurrence [62].…”

Dual-Energy CT: Benefits and Barriers to Adoption

“…Despite the positive impact identified by Atwi et al [2] and others, routine use of DECT is not yet widespread [8]. This is at least partially because of the economics of implementation, because DECT machines cost significantly more than single-energy models but usage of dual-energy technology does not result in increased reimbursement per examination.…”

“…Other concerns may impair adoption of DECT, some of which have become less applicable over time. These include an increase in the number of images per examination, which can be addressed by only sending images necessary for diagnosis to PACS and by designing automated hanging protocols for efficient image viewing [7,8]. Time required to create and send reconstructed series can be reduced through automation and optimizing client or server configurations.…”