Artery imaging, a crucial component in the diagnosis and management of vascular disease, assumes a significant role in the field of medical research. Utilizing advanced imaging modalities such as computed tomography (CT) and magnetic resonance angiography (MRA), artery imaging provides detailed insights into blood flow, detecting conditions such as atherosclerosis, aneurysms, and other vascular abnormalities with high precision. Spectral CT is an innovative imaging technique that goes beyond traditional CT scans, capturing data at multiple energy levels to provide detailed insights into the composition of tissues and materials within the scanned region. Notably, recent studies and clinical applications have underscored the diagnostic advantages offered by spectral CT in the detection and characterization of various arterial diseases. The integration of spectral CT into the realm of arterial imaging presents a promising avenue for improving the diagnosis and management of vascular disease. This comprehensive review aims to provide an extensive overview, delving into the potential benefits, optimization, challenges, and future of spectral CT in arterial imaging.