Han D, Shah S, Lee JH, et al. - The present study was undertaken to describe an approach to evaluate myocardial perfusion defect assessment for projection-based dual-energy CT (DECT). Using DECT and single energy cardiac computed tomography angiography (SECT), left ventricular (LV) phantoms with artificial perfusion defects were investigated. Researchers examined reconstructions of DECT-MCE at 40, 70, 100 and 140 keV, dual-energy CT-material decomposition (DECT-MD) pairs of water, iodine, iron and fat, and SECT by using a 17-segment myocardial model. The diagnostic performance of each reconstruction was estimated on a per-segment basis and correlated across DECT reconstructions. The results displayed that over 34 phantoms with artificial perfusion defects were detected in 64/578 (11%) of segments, the sensitivity of DECT-MCE at 40, 70, 100, and 140 keV was 100%, 100%, 71%, and 25%, respectively, with a significant decline between 70 keV and 100 keV. The outcomes suggested that the procedure with the best sensitivity and specificity to estimate myocardial perfusion defects with DECT are reconstructions of DECT-MCE at 40 or 70 KeV and DECT-MD without iodine background.