The Diagnostic Value of Dual-Energy CT in Differentiating Benign and Malignant Pulmonary Nodules
Submission: 01 January 2026 | Acceptance: 20 February 2026 | Publication: 24 April 2026
Dr Tahmoor Ghori1, Dr. Ameet Kumar Lalwani2, Dr Asad Jahangir3, Dr Ahmad Haroon4, Dr Qasim Raza5, Dr Faiza Maqsood6
1Lecturer, Fazaia Ruth Pfau Medical College, Karachi
2Associate Professor, Sindh Institute of Urology and Transplantation, Karachi Pakistan
3Senior Lecturer, Directorate of Education Development, Ziauddin University
4Assistant Professor, Bahria University Health Sciences Campus, Karachi
5Professor of Medicine, and Dean Shahida Islam Medical College, Lodhran
6Assistant Professor, Shahida Islam Medical College, Lodhran
ABSTRACT:
Background: Pulmonary nodules were commonly detected on imaging, posing a diagnostic challenge in distinguishing benign from malignant lesions. Accurate and early differentiation was essential for appropriate clinical management and prognosis. Dual-energy computed tomography (DECT) had emerged as an advanced imaging modality, providing functional and material-specific information that could improve diagnostic accuracy compared to conventional CT.
Aim: This study aimed to evaluate the diagnostic value of dual-energy CT in differentiating benign and malignant pulmonary nodules.
Methods: This cross-sectional study was conducted at Shifa International Hospital, Islamabad, from March 2025 to February 2026. A total of 110 patients with radiologically detected pulmonary nodules were included. Patients underwent dual-energy CT scanning using a standardized protocol. Quantitative parameters, including iodine concentration, effective atomic number, and spectral attenuation curves, were analyzed. Final diagnosis was confirmed through histopathology or clinical follow-up. Sensitivity, specificity, and diagnostic accuracy of DECT parameters were calculated to assess their effectiveness in differentiating benign from malignant nodules.
Results: Out of 110 pulmonary nodules, 62 (56.4%) were malignant and 48 (43.6%) were benign. Malignant nodules demonstrated significantly higher iodine concentration and steeper spectral attenuation slopes compared to benign nodules (p < 0.001). The sensitivity and specificity of DECT in differentiating malignant nodules were 90.3% and 85.4%, respectively, with an overall diagnostic accuracy of 88.2%. The combination of multiple DECT parameters further improved diagnostic performance. DECT showed a strong correlation with histopathological findings, reducing the need for invasive diagnostic procedures.
Conclusion: Dual-energy CT was found to be a highly reliable and non-invasive imaging modality for differentiating benign and malignant pulmonary nodules. Its ability to provide quantitative and functional information significantly enhanced diagnostic confidence and could aid in early and accurate clinical decision-making.
Keywords: Dual-energy CT, Pulmonary nodules, Benign lesions, Malignant lesions, Diagnostic accuracy, Iodine concentration, Spectral imaging.