Objectives <p>Myocardial computed tomography late enhancement (CT-LE) is a valuable modality used for the assessment of myocardial infarction and fibrosis and is effective in detecting latent cardiac amyloidosis. However, the optimal acquisition mode for CT-LE remains unknown. Here, we compared single-energy shuttle mode and DE mode for improving the quality of CT-LE imaging using dual-source CT.</p> Methods <p>Fifteen patients with suspected or known ischemic heart disease underwent CT-LE imaging 5 min after coronary CT in both shuttle and dual-energy (DE) modes. In DE mode, virtual monoenergetic images at various keVs were reconstructed, and extracellular volume (ECV) was quantified using iodine-specific images. For shuttle mode, ECV was assessed by subtracting the volume from pre-contrast images from CT-LE after non-rigid registration.</p> Results <p>In DE mode, signal-noise-to-ratio was the highest at 70 keV, but it was still lower than that in shuttle mode (<i>p</i> &lt; 0.001). Contrast-noise-to-ratio was the highest on DE mode at 40 keV and was comparable with that in shuttle mode (<i>p</i> = 0.51). Interobserver agreement for infarct detection was higher in shuttle mode (kappa = 0.981) compared to DE mode (kappa = 0.808). Global ECV was comparable between shuttle and DE modes (<i>p</i> = 0.96). However, the coefficient of variation of segmental ECV was significantly lower in shuttle mode (<i>p</i> &lt; 0.001).</p> Conclusion <p>Shuttle mode CT-LE demonstrates superior image quality, better agreement in infarct detection, and ECV consistency in comparison to DE mode, suggesting its potential as the preferred approach for CT-LE imaging using dual-source CT despite limited z-axis coverage of 10.5 cm.</p> Clinical relevance statement <p>CT late enhancement imaging in shuttle mode provides superior image quality and consistent extracellular volume measurements compared to dual-energy mode, highlighting its potential as the preferred acquisition method for CT late enhancement imaging in dual-source CT.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Shuttle mode and dual-energy acquisition are compared for optimal myocardial CT-late enhancement (CT-LE) imaging.</p> </ItemContent> <ItemContent> <p>Shuttle mode can provide better image quality and more consistent extracellular volume measurements.</p> </ItemContent> <ItemContent> <p>Despite limited coverage, shuttle mode may be preferred for myocardial CT-LE imaging.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>