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Dual-Energy and Spectral CT in Clinical Practice: 2nd Edition
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Dual-Energy and Spectral CT in Clinical Practice: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: 20 March 2026 | Viewed by 1551

Special Issue Editor

Dr. Giovanni Foti

E-Mail Website
Guest Editor
Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37042 Verona, Italy
Interests: MSK imaging; CT; DECT; MRI; shoulder; hip; adrenal; liver; pancreas; lung; infectious diseases; endometriosis
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Special Issue Information

Dear Colleagues,

We are excited to announce the second volume of our Special Issue, “Dual-Energy and Spectral CT in Clinical Practice: 2nd Edition”. The first volume is available at the following link: https://www.mdpi.com/journal/jcm/special_issues/EQDSQ646AJ.

Spectral CT systems, including dual-energy computed tomography (DECT) and photon-counting CT, represent powerful imaging tools in clinical practice. Due to its intrinsic high spatial and contrast resolution, DECT can be utilized to diagnose brain, body and skeletal disorders in both acute and elective settings. In particular, DECT has been widely employed to improve the identification of substances from different spectral information by using dedicated algorithms. DECT has been proposed as an alternative to MRI in musculo-skeletal radiology. Additionally, monoenergetic reconstructions can be employed in order to reduce metal-induced artifacts, or to increase the conspicuity of contrast material within the arterial and venous vessels or to increase the contrast in the abdominal parenchyma. In addition, DECT and spectral CT systems has been used to image oncologic patients via a qualitative and quantitative approach. In recent years, photon-counting CT has proven to be a reliable method in the complex diagnosis of cardiovascular diseases, not only for the detailed evaluation of coronary arteries but also for functional assessments. Additionally, it represents an extremely promising technique in the fields of oncology and musculoskeletal imaging.

The aim of this Special Issue is to provide a comprehensive overview of the role of dual-energy and spectral CT applications in clinical practice. Therefore, researchers working in the field of DECT, spectral CT or photon-counting CT are encouraged to submit their findings as original research articles or reviews to this Special Issue.

Dr. Giovanni Foti
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dual-energy CT
  • spectral CT
  • photon counting CT
  • oncology
  • bone marrow edema
  • prosthesis
  • liver
  • pancreas
  • lung
  • kidney
  • adrenal
  • brain
  • abdomen
  • cardiac
  • coronary arteries
  • arthritis

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Related Special Issue

Published Papers (2 papers)

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Research

14 pages, 2518 KB  
Article
Assessment of Intervertebral Lumbar Disk Herniation: Accuracy of Dual-Energy CT Compared to MRI
by Giuseppe Ocello, Gianluca Tripodi, Flavio Spoto, Leonardo Monterubbiano, Gerardo Serra, Giorgio Merci and Giovanni Foti
J. Clin. Med. 2025, 14(19), 7000; https://doi.org/10.3390/jcm14197000 - 3 Oct 2025
Viewed by 542
Abstract
Background: Lumbar disk herniation is a common cause of low back pain and radiculopathy, significantly impacting patients’ life quality and functional capacity. Magnetic Resonance Imaging (MRI) remains the gold standard for its assessment due to its superior soft tissue contrast and multiplanar imaging [...] Read more.
Background: Lumbar disk herniation is a common cause of low back pain and radiculopathy, significantly impacting patients’ life quality and functional capacity. Magnetic Resonance Imaging (MRI) remains the gold standard for its assessment due to its superior soft tissue contrast and multiplanar imaging capabilities. However, recent advances in spectral computed tomography (CT), particularly dual-energy CT (DECT), have introduced new diagnostic opportunities, offering improved soft tissue characterization. Objective: To evaluate the diagnostic performance of DECT in detecting and grading lumbar disk herniations using dedicated color-coded fat maps. Materials and Methods: A total of 205 intervertebral levels from 41 consecutive patients with lumbar symptoms were prospectively analyzed. All patients underwent both DECT and MRI within 3 days. Three radiologists with varying years of experience independently assessed DECT images using color-coded reconstructions. A five-point grading score was attributed to each lumbar level: 1 = normal disk, 2 = bulging/protrusion, 3 = focal herniation, 4 = extruded herniation, and 5 = migrated fragment. The statistical analysis included Pearson’s correlation for score consistency, Cohen’s Kappa for interobserver agreement, generalized estimating equations for a cluster-robust analysis, and an ROC curve analysis. The DECT diagnostic accuracy was assessed in a dichotomized model (grades 1–2 = no herniation; 3–5 = herniation), using MRI as reference. Results: A strong correlation was observed between DECT and MRI scores across all readers (mean Pearson’s r = 0.826, p < 0.001). The average exact agreement between DECT and MRI was 79.4%, with the highest concordance at L1–L2 (86.7%) and L5–S1 (80.4%). The interobserver agreement was substantial (mean Cohen’s κ = 0.765), with a near-perfect agreement between the two most experienced readers (κ = 0.822). The intraclass correlation coefficient was 0.906 (95% CI: 0.893–0.918). The ROC analysis showed excellent performance (AUC range: 0.953–0.986). In the dichotomous model, DECT demonstrated a markedly higher sensitivity than conventional CT (95.1% vs. 57.2%), with a comparable specificity (DECT: 99.0%; CT: 96.5%) and improved overall accuracy (98.4% vs. 90.0%). Subgroup analyses by age and disk location revealed no statistically significant differences. Conclusions: The use of DECT dedicated color-coded fat map reconstructions showed high diagnostic performance in the assessment of lumbar disk herniations compared to MRI. These findings support the development of dedicated post-processing tools, facilitating the broader clinical adoption of spectral CT, especially in cases where MRI is contraindicated or less accessible. Full article
(This article belongs to the Special Issue Dual-Energy and Spectral CT in Clinical Practice: 2nd Edition)
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12 pages, 2478 KB  
Article
Diagnostic Accuracy of Dual-Energy CT Parameters for Discrimination of Hypodense Liver Lesions in Patients Affected by Colorectal Cancer
by Tommaso D’Angelo, Ludovica R. M. Lanzafame, Timo Steinert, Silvio Mazziotti, Manuela França, Ahmed E. Othman, Mirela Dimitrova, Scherwin Mahmoudi, Ibrahim Yel, Leona S. Alizadeh, Leon D. Grünewald, Vitali Koch, Simon S. Martin, Thomas J. Vogl and Christian Booz
J. Clin. Med. 2025, 14(17), 5929; https://doi.org/10.3390/jcm14175929 - 22 Aug 2025
Viewed by 692
Abstract
Objective: The aim of this study was to evaluate the diagnostic accuracy of conventional CT values and the dual-energy computed tomography (DECT)-derived effective atomic number (Zeff), fat fraction (FF) and iodine concentration (IC) for the differentiation of hypodense liver lesions in patients [...] Read more.
Objective: The aim of this study was to evaluate the diagnostic accuracy of conventional CT values and the dual-energy computed tomography (DECT)-derived effective atomic number (Zeff), fat fraction (FF) and iodine concentration (IC) for the differentiation of hypodense liver lesions in patients with colorectal cancer (CRC). Methods: One hundred and twenty patients (mean age: 65 ± 12 years) affected by CRC who underwent dual-source DECT as part of tumor staging between December 2015 and June 2023 were retrospectively evaluated. Spectral datasets were reconstructed for each patient and regions of interest were applied at the level of hypodense liver lesions to collect CT, Zeff, FF and IC values. To assess diagnostic accuracy, receiver operating characteristic (ROC) curves were constructed to evaluate the area under the curve (AUC), sensitivity, and specificity using biopsy or MRI (in cases when biopsy was not indicated or feasible) as a reference standard. The Youden index was used to identify optimal cut-off values for potential clinical applications. Results: A total of 223 lesions (147 metastases and 76 cysts) were evaluated. CT, FF and IC values differed significantly between metastases and cysts (p < 0.0001), showing high diagnostic accuracy. FF showed significantly higher diagnostic accuracy compared to all other parameters (all p ≤ 0.0074), with an AUC value of 0.97 (95% CI: 0.94–0.99). For a cut-off > 15.9, the sensitivity reached 91.8% (95% CI: 86.2–95.7) and the specificity reached 98.7% (95% CI: 92.9–100). Zeff numbers did not differ considerably (p = 0.781) between the two entities and demonstrated a lower AUC (0.511; 95% CI: 0.44–0.58). Conclusions: FF measurements proved to have high diagnostic accuracy compared to CT values, IC, and Zeff in the evaluation of hypodense liver lesions in patients suffering from colorectal carcinoma. Full article
(This article belongs to the Special Issue Dual-Energy and Spectral CT in Clinical Practice: 2nd Edition)
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