Abstract
Urolithiasis is a common disease with a reported prevalence between 4% and 20% in the worldwide. Determination of urinary calculi composition is a key factor in preoperative evaluation, treatment, and recurrence prevention. Dual-energy computed tomography (DECT) is available methods for determining urinary stone composition were only available after stone extraction, and thereby unable to aid in optimized stone management prior to intervention. DECT utilizes the attenuation difference produced by two different x-ray energy spectra to quantify urinary calculi composition while still providing the information attained with a conventional CT. Knowledge of DECT imaging pitfalls and stone mimics is important, as the added benefit of dual-energy analysis is the determination of stone composition, which in turn affects all aspects of stone management.
 This article describes DECT principles, scanner types and acquisition protocols for the evaluation of urinary calculi as they relate to imaging pitfalls (inconsistent characterization of small stones, small DECT field of view, and mischaracterization from surrounding material) and stone mimics (drainage devices) that may adversely impact clinical decisions.
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