Dual-Energy Ct (DETC) dalam Praktik Klinis: Dari Batu Ginjal Hingga Emboli Paru dan Gout - Sebuah Literature Review

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ABSTRACT

Dual-energy computed tomography (DECT) has emerged as a spectral CT technique that overcomes key limitations of single-energy CT by exploiting energy-dependent attenuation to perform material decomposition and generate quantitative derivative images. This narrative literature review summarizes physical principles, reconstruction techniques, and key clinical applications of DECT in urolithiasis, pulmonary embolism, and gout, as well as its limitations, radiation issues, and future directions. A structured search of recent experimental, clinical, and meta-analytic studies on DECT was performed using major radiology and multidisciplinary journals. Articles were grouped according to technical concepts, kidney stone characterization, pulmonary perfusion imaging, and urate crystal detection, and were critically synthesized. The reviewed evidence shows that DECT reliably differentiates uric acid from non-uric acid stones with high pooled sensitivity and specificity, potentially replacing conventional stone analysis and allowing earlier alkalinization therapy. In pulmonary embolism, DECT enriches CT pulmonary angiography by combining low-keV virtual monoenergetic images with iodine perfusion maps and perfused blood volume metrics, thereby improving clot detection under suboptimal opacification and enabling quantitative assessment of perfusion defects. In gout, color-coded DECT maps demonstrate high diagnostic accuracy for monosodium urate deposition and permit volumetric quantification of crystal burden, although sensitivity decreases in very early disease and artefacts may generate false positives. DECT currently represents a mature and versatile spectral CT platform that integrates anatomic and functional information across multiple organ systems; however, standardisation of protocols, mitigation of artefacts, and development of advanced multi-material and photon-counting techniques remain crucial for wider clinical adoption.

Keywords: Dual-Energy CT, Kidney Stones, Pulmonary Embolism, Gout, Spectral Imaging.

ABSTRAK

Dual-energy computed tomography (DECT) berkembang sebagai teknik CT spektral yang mengatasi keterbatasan CT energi tunggal dengan memanfaatkan perbedaan atenuasi terhadap dua spektrum energi untuk melakukan material decomposition dan menghasilkan citra turunan kuantitatif. Tinjauan pustaka ini merangkum prinsip dasar, teknik rekonstruksi, serta aplikasi klinis utama DECT pada batu ginjal, emboli paru, dan gout, sekaligus membahas keterbatasan, isu dosis radiasi, dan arah pengembangan teknologi. Dilakukan penelusuran terstruktur terhadap artikel eksperimental, studi klinis, dan meta-analisis terkait DECT pada jurnal radiologi dan kedokteran multidisiplin. Literatur diklasifikasikan berdasarkan aspek teknis, karakterisasi komposisi batu ginjal, pemetaan perfusi paru, dan deteksi kristal monosodium urat, kemudian disintesis secara naratif dan kritis. Bukti yang dihimpun menunjukkan DECT mampu membedakan batu asam urat dan non asam urat dengan sensitivitas dan spesifisitas tinggi sehingga berpotensi menggantikan analisis batu konvensional dan memungkinkan inisiasi terapi alkalinisasi lebih dini. Pada emboli paru, DECT menambahkan rekonstruksi virtual monoenergetic energi rendah dan iodine perfusion map di atas CT pulmonary angiography konvensional, sehingga meningkatkan deteksi trombus pada opasifikasi suboptimal dan menyediakan parameter perfused blood volume untuk menilai defisit perfusi secara kuantitatif. Pada gout, peta warna DECT menunjukkan akurasi diagnostik tinggi untuk mendeteksi deposisi kristal urat dan memungkinkan kuantifikasi beban kristal, walaupun sensitivitas menurun pada penyakit sangat dini dan artefak dapat menimbulkan hasil positif palsu. DECT saat ini merepresentasikan platform CT spektral yang matang dan serbaguna yang mengintegrasikan informasi morfologi dan fungsional lintas sistem organ, namun masih memerlukan standardisasi protokol, pengendalian artefak, serta pengembangan algoritma multi-material dan teknologi photon-counting untuk implementasi yang lebih luas. 

Kata Kunci: Dual-Energy CT, Batu Ginjal, Emboli Paru, Gout, Pencitraan Spektral.