Diagnostic Value of Dual-Energy CT Versus Single-Energy CT in Abdominal Imaging: A Cross-Sectional Comparative Study

Abstract

Background:
Dual-Energy Computed Tomography (DECT) has emerged as a promising imaging modality offering enhanced tissue characterization compared to traditional Single-Energy Computed Tomography (SECT). This study aimed to evaluate the diagnostic value of DECT versus SECT in abdominal imaging within the Al Ahsa region.

Methods:
A cross-sectional comparative study involving 198 patients referred for abdominal CT scans. Participants were assigned to the DECT group (n = 97) or the SECT group (n = 101) using systematic random sampling. Imaging findings were independently evaluated by two blinded radiologists. Diagnostic performance metrics, lesion detection and characterization, diagnostic confidence, inter-observer agreement, radiation dose estimates, and impact on clinical management were assessed.

Results:
DECT demonstrated significantly higher sensitivity (94.8% vs. 79.2%; p < 0.001) and specificity (89.7% vs. 74.5%; p < 0.001) compared to SECT. A total of 148 lesions were detected with DECT versus 119 with SECT, with DECT identifying 29 additional lesions. Lesion conspicuity scores were significantly higher in the DECT group (4.6 ± 0.5) compared to SECT (3.7 ± 0.8; p < 0.001). Subgroup analysis revealed superior performance of DECT across all lesion types, including hepatic lesions (57 vs. 43; p < 0.001), renal calculi (40 vs. 34; p < 0.001), vascular abnormalities (31 vs. 25; p = 0.01), and inflammatory conditions (20 vs. 17; p = 0.04). Diagnostic confidence was greater with DECT (mean score 4.8 ± 0.4 vs. 4.1 ± 0.7; p < 0.001), and inter-observer agreement was higher (κ = 0.87 vs. κ = 0.69; p = 0.03). Although DECT was associated with a slightly higher radiation dose, it remained within acceptable safety margins.

Conclusion:
DECT offers significant advantages over SECT in abdominal imaging, including higher diagnostic accuracy, improved lesion detection and characterization, increased diagnostic confidence, and greater impact on clinical management. These findings support the integration of DECT into routine abdominal imaging protocols for enhanced diagnostic performance and clinical decision-making.