Dual-energy CT of the heart current and future status

•Dual-energy cardiac CT (DECT) has transitioned from the realm of research into clinical workflows.•DECT techniques can provide improved subjective evaluations and allow quantitative imaging.•DECT may allow for more gentle imaging because of the potential to decrease requisite radiation and contrast material doses.•Several promising investigational techniques are outlined for future directions. Several applications utilizing dual-energy cardiac CT (DECT) have recently transitioned from the realm of research into clinical workflows. DECT acquisition techniques and subsequent post-processing can provide improved qualitative analysis, allow quantitative imaging, and have the potential to decrease requisite radiation and contrast material doses. Additionally, several experimental DECT techniques are pending further investigation and may improve the diagnostic accuracy of cardiac CT and/or provide evaluation of emerging imaging biomarkers in the future. This review article will summarize the major applications utilizing DECT in diagnosis of cardiovascular disease, including both the clinically used and investigational techniques examined to date.