Unpacking the knee: diagnostic insights from dual-energy CT

Abstract Dual-energy computed tomography (DECT) is an emerging imaging modality increasingly utilized in evaluating knee pathology due to its ability to exploit differential tissue attenuation at two energy levels. Recent literature has highlighted its diagnostic accuracy in detecting bone marrow edema (BME), a critical indicator of both traumatic and non-traumatic knee conditions. Additionally, DECT demonstrates enhanced capability in assessing soft-tissue integrity, providing detailed visualization of ligaments and tendons, including accurate identification of ligamentous injuries such as anterior cruciate ligament tears. Furthermore, DECT effectively differentiates crystal arthropathies, such as gout and calcium pyrophosphate deposition disease, enabling precise diagnosis and facilitating monitoring of disease progression and therapeutic response. Lastly, DECT substantially reduces metal-induced artifacts common in postoperative knee imaging, significantly improving the assessment of prosthetic positioning, alignment, periprosthetic fractures, and associated complications. This review summarizes the current applications of DECT in knee imaging, emphasizing its clinical advantages, diagnostic accuracy, and potential role as a practical alternative or adjunct to magnetic resonance imaging (MR) imaging.