By Katherine Anderson
Multi-Energy CT (MECT) is underused in emergency settings, especially in high-volume, non-academic practices, according to Nicolas Murray, MD, FRCPC, clinical associate professor of radiology at Vancouver General Hospital at the University of British Columbia.
During a Wednesday session, Dr. Murray and fellow speakers used case-based presentations and practical insights to demonstrate how MECT can enhance diagnostic accuracy and clinical decision-making in the emergency department.
“MECT assessment can improve the degree of diagnostic certainty of a case being normal or abnormal by shifting the level of confidence away from being indeterminate or questionable,” Dr. Murray said. “MECT can demonstrate pathologies that are not visible, or are less conspicuous, on conventional CT images, ultimately improving diagnostic accuracy.”
Especially in acute settings, MECT reduces uncertainty by providing new image types, color data and streamlined workflows.
“Being able to characterize these abnormalities accurately without having to recommend further testing has been demonstrated in the literature to save time, radiation dose to the patient and money to the system.”
Nicolas Murray, MD, FRCPC
“In emergency settings, radiologists will commonly have to assess incidental, non-acute findings, such as non-cystic renal or hepatic lesions, adrenal nodules, age-indeterminate fractures and mineralized soft tissue deposits that could represent gout,” Dr. Murray said. “Being able to characterize these abnormalities accurately without having to recommend further testing has been demonstrated in the literature to save time, radiation dose to the patient and money to the system.”
Throughout his presentation, Dr. Murray highlighted examples of how MECT enhances confidence, improves detection of subtle or invisible findings, and pushes diagnostic boundaries of CT.
Differentiating between acute and chronic injuries, such as the case with vertebral fractures, is one of the many cases. Gallstones, particularly those similar in density to bile, are also more readily detected using low-kv reconstructions that increase attenuation differences.
MECT can also prevent mistakes by revealing findings that might be overlooked on conventional CT, helping clinicians make timely and accurate decisions. For instance, a case of suspected pelvic inflammatory disease was ultimately identified as tubal torsion after MECT showed fallopian tube thickening without enhancement.
Adoption of MECT can be limited by workflow concerns, unfamiliarity with post-processing software or hesitation to change established protocols. Addressing these issues, Dr. Murray emphasized the importance of support from vendors, application specialists or what he calls “champion” radiologists—experts who ensure protocols are set up correctly before the technology reaches the broader radiology team.
“When used well, MECT increases diagnostic confidence, improves workflow and enhances patient care,” Dr. Murray concluded.
Access the presentation, “MECT in the Emergent Setting,” (W6-CER11C) on demand at RSNA.org/MeetingCentral.
© 2025 RSNA.
The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
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