Dual-Energy Computed Tomography, a New Metal Artifact Reduction Technique for Total Hip Arthroplasty: Is There a Light in the Darkness?

: Background/Objectives: To evaluate dual-energy computed tomography (DECT) in comparison with conventional CT for periprosthetic bone and surrounding soft tissues in total hip arthroplasty (THA). Methods: Two authors independently screened titles and abstracts for eligibility, discussing any disagreements with a third author for final decisions. The articles were categorized into two main groups: those focusing on periprosthetic bone and those on blood vessels or pelvic organs. Results: A total of 37 articles were selected to be included in this systematic review. Conclusions: Our systematic review reveals significant variability in the use of DECT for periprosthetic bone and soft tissue imaging, due to differences in equipment, protocols, and clinical settings. While many studies indicate that virtual monochromatic imaging (VMI), especially when combined with metal artifact reduction (MAR), improves image quality, there is no consensus on optimal energy levels. Future research should focus on large-scale, multicenter studies with standardized protocols to compare reconstruction techniques, energy levels, and combined MAR-VMI use.