Ludovica Scalzone

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.

Acute mesenteric ischemia (AMI) is a clinical condition caused by vascular insufficiency, resulting in intestinal damage. Is often underestimated, if not driven by clinical suspicion, due to the non-specific clinical symptoms (usually represented by acute abdominal pain) and the absence of reliable markers, which results in a poor prognosis and high mortality. We can identify three main forms of AMI: arterial, venous, and non-occlusive. Arterial AMI is the most frequent form, caused by occlusion of the superior mesenteric artery or one of its branches. Venous AMI is the least frequent, caused by thrombosis of the superior mesenteric vein or its branches. Non-occlusive AMI is due to a state of hypovolemia, which is frequent in patients who have undergone surgery. Given the difficulty of diagnosis based on the clinic alone, the radiologist plays a central role in identifying radiological signs of intestinal ischemia and in avoiding misdiagnosis. The radiologist’s role is mainly to identify factors predictive of necrosis, which allow us to stratify patients and direct them towards the proper management. The aim of this review is to provide indications for an adequate CT protocol, including an unenhanced phase, an arterial phase, and a venous phase, as well as to underline the features to investigate in the different forms of AMI, in order to increase the diagnostic capacity in this challenging disease.

Pancreatic cystic lesions (PCLs) are increasingly detected due to widespread use of cross-sectional imaging. They encompass a heterogeneous group of lesions, ranging from benign pseudocysts and serous cystic neoplasms (SCNs) to premalignant mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), as well as rare malignant entities such as solid pseudopapillary epithelial neoplasm (SPENs) and cystic pancreatic neuroendocrine tumors (cystic PanNETs). Management of PCLs depends on their malignant potential; therefore, an accurate classification is essential for optimizing treatment. This narrative review summarizes current knowledge on the epidemiology, imaging characteristics, diagnosis, and management of PCLs, highlighting the role of CT, MRI, MRCP, and endoscopic ultrasound. Recent advances in radiomics for lesion characterization and risk stratification, particularly in IPMNs, are discussed.