Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 22;14(17):5929.
doi: 10.3390/jcm14175929.

Diagnostic Accuracy of Dual-Energy CT Parameters for Discrimination of Hypodense Liver Lesions in Patients Affected by Colorectal Cancer

Tommaso D'Angelo  1 , Ludovica R M Lanzafame  1 , Timo Steinert  2   3 , Silvio Mazziotti  1 , Manuela França  4 , Ahmed E Othman  5 , Mirela Dimitrova  2   3 , Scherwin Mahmoudi  2   3 , Ibrahim Yel  2   3 , Leona S Alizadeh  2   3 , Leon D Grünewald  2   3 , Vitali Koch  2   3 , Simon S Martin  2   3 , Thomas J Vogl  3 , Christian Booz  2   3
Affiliations

Diagnostic Accuracy of Dual-Energy CT Parameters for Discrimination of Hypodense Liver Lesions in Patients Affected by Colorectal Cancer

Tommaso D'Angelo et al. J Clin Med. .

Abstract

Objective: The aim of this study was to evaluate the diagnostic accuracy of conventional CT values and the dual-energy computed tomography (DECT)-derived effective atomic number (Zeff), fat fraction (FF) and iodine concentration (IC) for the differentiation of hypodense liver lesions in patients with colorectal cancer (CRC). Methods: One hundred and twenty patients (mean age: 65 ± 12 years) affected by CRC who underwent dual-source DECT as part of tumor staging between December 2015 and June 2023 were retrospectively evaluated. Spectral datasets were reconstructed for each patient and regions of interest were applied at the level of hypodense liver lesions to collect CT, Zeff, FF and IC values. To assess diagnostic accuracy, receiver operating characteristic (ROC) curves were constructed to evaluate the area under the curve (AUC), sensitivity, and specificity using biopsy or MRI (in cases when biopsy was not indicated or feasible) as a reference standard. The Youden index was used to identify optimal cut-off values for potential clinical applications. Results: A total of 223 lesions (147 metastases and 76 cysts) were evaluated. CT, FF and IC values differed significantly between metastases and cysts (p < 0.0001), showing high diagnostic accuracy. FF showed significantly higher diagnostic accuracy compared to all other parameters (all p ≤ 0.0074), with an AUC value of 0.97 (95% CI: 0.94-0.99). For a cut-off > 15.9, the sensitivity reached 91.8% (95% CI: 86.2-95.7) and the specificity reached 98.7% (95% CI: 92.9-100). Zeff numbers did not differ considerably (p = 0.781) between the two entities and demonstrated a lower AUC (0.511; 95% CI: 0.44-0.58). Conclusions: FF measurements proved to have high diagnostic accuracy compared to CT values, IC, and Zeff in the evaluation of hypodense liver lesions in patients suffering from colorectal carcinoma.

Keywords: colorectal cancer; cysts; dual energy computed tomography; neoplasm metastasis.

PubMed Disclaimer

Conflict of interest statement

C.B. and I.Y. have received speaking fees from Siemens Healthineers. T.D. has received speaking fees from Bracco and Philips. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Axial portal-venous phase Z-effective maps showing ROI positioning in a metastatic liver lesion (A) and in a benign cyst (B).
Figure 3
Figure 3
Box-and-whisker plots showing considerable differences in CT value, FF, and IC distribution in liver CRC metastases and benign cysts (p < 0.0001) (A,B,D). The Zeff values were comparable between the two lesion types (p = 0.781) (C).
Figure 4
Figure 4
ROC curve comparison of CT, FF, Zeff, and IC values’ diagnostic accuracy evaluated using liver MRI or biopsy as a reference standard.
See this image and copyright information in PMC

References

    1. Ciardiello F., Ciardiello D., Martini G., Napolitano S., Tabernero J., Cervantes A. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA Cancer J. Clin. 2022;72:372–401. doi: 10.3322/caac.21728. - DOI - PubMed
    1. Siegel R.L., Miller K.D., Fuchs H.E., Jemal A. Cancer statistics, 2022. CA Cancer J. Clin. 2022;72:7–33. doi: 10.3322/caac.21708. - DOI - PubMed
    1. Jasperson K.W., Tuohy T.M., Neklason D.W., Burt R.W. Hereditary and familial colon cancer. Gastroenterology. 2010;138:2044–2058. doi: 10.1053/j.gastro.2010.01.054. - DOI - PMC - PubMed
    1. Sawicki T., Ruszkowska M., Danielewicz A., Niedźwiedzka E., Arłukowicz T., Przybyłowicz K.E. A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis. Cancers. 2021;13:2025. doi: 10.3390/cancers13092025. - DOI - PMC - PubMed
    1. Dekker E., Tanis P.J., Vleugels J.L.A., Kasi P.M., Wallace M.B. Colorectal cancer. Lancet. 2019;394:1467–1480. doi: 10.1016/S0140-6736(19)32319-0. - DOI - PubMed