What you don't see matters: dual-energy CT in emergency radiology

Dual-Energy Computed Tomography (DECT) represents a technological breakthrough in diagnostic imaging, offering the unique ability to characterize and differentiate tissues. This review analyzes the expanding role of DECT within emergency radiology, highlighting how its added value over conventional CT improves decision-making in acute clinical settings. In emergency neuroradiology, DECT allows for a critical distinction between acute intracranial hemorrhage and iodinated contrast extravasation. In vascular emergencies, it optimizes the evaluation of the arterial tree and is crucial for the timely diagnosis of acute pulmonary embolism through iodine perfusion maps that identify subtle filling defects. In acute abdominal imaging, DECT improves the characterization of traumatic or inflammatory lesions and enables precise chemical mapping of renal calculi, differentiating uric acid from calcium oxalate to guide immediate therapy. Finally, in emergency musculoskeletal imaging, calcium suppression algorithms accurately visualize bone marrow edema, helping to detect occult fractures and acute traumatic injuries. In conclusion, DECT has transitioned from a research tool to an essential asset in emergency radiology. By significantly enhancing diagnostic accuracy and streamlining workflows, DECT optimizes patient triage and management in time-critical acute scenarios across multiple anatomical regions.