## 6 Conclusions  
Over the past decade, LGE-CMR has played a crucial role in various heart diseases due to its advantages, including the absence of ionizing radiation, a high contrast resolution, and robust clinical evidence supporting the prognostic value of myocardial late enhancement. Despite its appeal, LGE-CMR faces safety concerns, higher costs, and longer scanning times, which has prompted the exploration of alternatives, particularly LIE-CT. The potential for LIE-CT as an alternative is driven not only by the costs but also by the growing population with implantable cardiac devices, impacting the CMR image quality, and other CMR limitations, such as claustrophobia. Nowadays, several studies have demonstrated the high accuracy of LIE, in most cases overlapping with those shown by CMR, in the diagnosis and differentiation of myocardial pathologic entities, from acute MI to chronic fibrotic modifications, as well as in non-ischemic heart diseases. Thus, despite some evident limitations, such as its inability to detect diffuse myocardial delayed enhancement, LIE-CT should be included in CCT protocols. This is particularly useful in acute clinical settings where magnetic resonance imaging availability is not always guaranteed, providing valuable prognostic and management information with optimized protocols characterized by low radiation doses and minimal contrast medium administration. However, it is important to consider that, despite the overall promising results, only a few studies support these findings, and many of them have limitations. Indeed, several studies have a very limited number of patients or are presented as case reports, particularly in non-ischemic pathologies. Due to these reasons, we cannot yet assert that LIE-CT can fully replace LGE-MRI when the latter is available and feasible. Future studies with larger sample sizes are needed to validate these findings.  
Conceptualization, D.D.S. and F.V.; methodology, D.S. and M.P.; validation, D.D.S., F.V., D.S., M.P., E.F., B.B.Z. and R.F.G.; formal analysis D.D.S.; investigation, F.V.; resources, F.V., D.D.S. and D.S.; data curation, D.S., A.N., F.L., C.F., O.G., R.B., C.M., M.L. and M.C.; writing--original draft preparation, F.V and M.P.; writing--review and editing, F.V. and D.S.; visualization, D.S. and D.D.S.; supervision, D.D.S., E.F. and R.F.G.; project administration, E.F. All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
Not applicable.  
The authors declare no conflicts of interest.  
\begin{table}
\begin{tabular}{c c} \hline \hline
**Advantages** & **Disadvantages** \\ \hline Wide availability & Use of ionizing radiation \\ \hline Short scan times & Availability of dual-energy CT \\ \hline Possibility of being utilized in acute settings, & Difficulty in detecting diffuse myocardial LIE \\ integrating it into triple-rule-out protocols & Patients with contraindications to iodinated \\ \hline Useful in patients with contraindications to & Contrast media \\ magnetic resonance imaging or patients who & \\ cannot tolerate long scan times & \\ \hline \hline \end{tabular}
\end{table}
Table 2: The primary advantages and disadvantages of LIE-CT.