Thoracic Diseases: Technique and Applications of Dual-Energy CT

Abstract

Dual-energy computed tomography (DECT) is one of the most promising technological innovations made in the field of imaging in recent years. Thanks to its ability to provide quantitative and reproducible data, and to improve radiologists’ confidence, especially in the less experienced, its applications are increasing in number and variety. In thoracic diseases, DECT is able to provide well-known benefits, although many recent articles have sought to investigate new perspectives. This narrative review aims to provide the reader with an overview of the applications and advantages of DECT in thoracic diseases, focusing on the most recent innovations. The research process was conducted on the databases of Pubmed and Cochrane. The article is organized according to the anatomical district: the review will focus on pleural, lung parenchymal, breast, mediastinal, lymph nodes, vascular and skeletal applications of DECT. In conclusion, considering the new potential applications and the evidence reported in the latest papers, DECT is progressively entering the daily practice of radiologists, and by reading this simple narrative review, every radiologist will know the state of the art of DECT in thoracic diseases.

Multimodality imaging of acute and chronic pulmonary thromboembolic disease

“…Dedicated post-processing software uses this data to create perfusion maps, that can provide additional information concerning the obstructive burden of PE and its effects on lung perfusion [ 19 ]. Although several authors highlighted the high sensitivity and specificity of DECT for detecting PE, the superiority of this technique in comparison with conventional single-source CT is still debated [ 20 ]. A possible advantage of DECT could be the detection of small perfusion defects secondary to subsegmental PE, which are difficult to detect on conventional CTPA, but there is also an ongoing debate on the clinical significance of these findings and how to treat these patients, with the main approaches being clinical surveillance and anticoagulation ( figure 2 ) [ 4 , 21 ].…”

Utility of Dual-Energy Computed Tomography in Clinical Conundra

“…Utilizing low keV VMI achieves a significant increase in iodine attenuation thereby enhancing the visibility of iodine-containing structures and helps distinguish enhancing from non-enhancing lesions [69]. Employing VNC imaging may result in a notable decrease in the overall administered contrast dose, as pre-contrast scans become unnecessary [69].…”

“…Utilizing low keV VMI achieves a significant increase in iodine attenuation thereby enhancing the visibility of iodine-containing structures and helps distinguish enhancing from non-enhancing lesions [69]. Employing VNC imaging may result in a notable decrease in the overall administered contrast dose, as pre-contrast scans become unnecessary [69]. Additionally, high-energy VMI can be utilized to mitigate beam hardening artifacts typically observed in the thorax due to dorsal spine stabilization for scoliosis [70][71][72].…”