Spectral computed tomography (CT) in breast lesion evaluation: clinical utility and imaging spectrum-a pictorial...

Breast lesions constitute a significant proportion of women's health imaging. While mammography, ultrasound, and magnetic resonance imaging (MRI) are well established methods of breast assessment, the radiation penalty associated with computed tomography (CT) limits its role mainly to incidental detection of breast lesions, oncological staging, and follow-up. Spectral CT, including dual-energy CT and photon-counting CT enables advanced postprocessing techniques such as iodine maps, monoenergetic reconstructions, and material decomposition which may aid in lesion breast detection, characterisation, and oncological treatment response monitoring. This article illustrates the utility of spectral CT in a range of benign and malignant breast lesions, with correlation to conventional breast imaging. A series of benign and malignant breast lesions, alongside relevant iodine maps, monoenergetic reconstructions, and material decomposition will be demonstrated, with corresponding conventional breast imaging. The clinical applications in lesion detection, differentiation between benign and malignant lesions, staging, prognostication, and treatment response will be discussed. Whilst spectral CT will not replace conventional breast imaging methods, it has a role as a valuable adjunct to aid the radiologist in routine clinical practice. Emerging functional and quantitative capabilities have the potential for objective lesion assessment and further integration of CT into breast imaging practice.