Application of DECT in the diagnosis, treatment and prognosis evaluation of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer and remains a major global health burden. With recent advancements in imaging technology, Dual-Energy Computed Tomography (DECT) has emerged as a valuable tool for improving diagnostic accuracy, treatment planning, and prognostic assessment of HCC. By leveraging its superior energy resolution, DECT provides multiparametric imaging that surpasses the intrinsic constraints of traditional single-energy CT (SECT). It enables the reconstruction of various spectral images and quantitative parameters, including virtual monochromatic images (VMIs), iodine maps, virtual non-contrast (VNC) images, and effective atomic number ( Z eff ) maps. These derivatives facilitate enhanced detection, characterization, and quantitative assessment of HCC. Furthermore, this review explores the utility of DECT in monitoring treatment response following locoregional therapies, including radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). Iodine quantification and spectral attenuation curves provide critical insights into post-treatment tissue perfusion and hemodynamic changes, facilitating the accurate assessment of tumor viability and therapeutic efficacy. This review delineates the current clinical applications, emerging trends, and existing challenges of DECT in the multifaceted management of HCC, encompassing diagnosis, treatment monitoring, and prognostic stratification.