Dual-Energy CT in Oncologic Imaging

Abstract

Dual-energy CT (DECT) is an innovative technology that is increasingly widespread in clinical practice. DECT allows for tissue characterization beyond that of conventional CT as imaging is performed using different energy spectra that can help differentiate tissues based on their specific attenuation properties at different X-ray energies. The most employed post-processing applications of DECT include virtual monoenergetic images (VMIs), iodine density maps, virtual non-contrast images (VNC), and virtual non-calcium (VNCa) for bone marrow edema (BME) detection. The diverse array of images obtained through DECT acquisitions offers numerous benefits, including enhanced lesion detection and characterization, precise determination of material composition, decreased iodine dose, and reduced artifacts. These versatile applications play an increasingly significant role in tumor assessment and oncologic imaging, encompassing the diagnosis of primary tumors, local and metastatic staging, post-therapy evaluation, and complication management. This article provides a comprehensive review of the principal applications and post-processing techniques of DECT, with a specific focus on its utility in managing oncologic patients.

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

“…In the oncologic field, these parameters may play a pivotal role in tumor management, including diagnosis, characterization, grading, assessment of tumor invasiveness, staging, histopathological and molecular typing (ki-67 or PD-L1 expression, HER-2 status, K-RAS mutations, etc. ), prognostic and predictive value, treatment planning, response assessment, and follow up [63][64][65][66][67][68][69][70][71][72][73][74]. In this setting, quantitative tumor biomarkers based on DECT include iodine concentration, Zeff values, and HU values [36,37,[75][76][77][78].…”