Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2025; 31(32): 110573
Published online Aug 28, 2025. doi: 10.3748/wjg.v31.i32.110573
Diagnostic accuracy of dual-layer spectral computed tomography virtual monoenergetic imaging with multiplanar reformation for T-staging of colorectal cancer
Fei-Xiang Chen, Ke-Ke Jiang, Jian-Feng Zhu, Mei-Rong Wang, Xiao-Le Fan, Ju-Shun Yang, Bo-Sheng He
Fei-Xiang Chen, Jian-Feng Zhu, Mei-Rong Wang, Xiao-Le Fan, Ju-Shun Yang, Bo-Sheng He, Department of Radiology, Nantong First People’s Hospital, Affiliated Hospital 2 of Nantong University, Nantong 226001, Jiangsu Province, China
Ke-Ke Jiang, Department of Radiology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Bo-Sheng He, Clinical Medicine Research Center, Nantong First People’s Hospital, Affiliated Hospital 2 of Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Chen FX, He BS, and Yang JS designed the research; Wang MR, Fan XL, Jiang KK, and Zhu JF collected the research data; Chen FX, Zhu JF, Jiang KK, and Yang JS analyzed and interpreted the research data; Chen FX and He BS performed statistical analysis; Chen FX, He BS, Yang JS, and Fan XL provided funding support; Chen FX and Yang JS wrote the manuscript; He BS and Yang JS revised the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Supported by Jiangsu Province 333 Talent Key Industry Field Talent Project, No. [2022]21; Key Scientific Research Program of Jiangsu Provincial Health Committee, No. ZD2021059; Nantong Key Laboratory Project, No. [2020]163; The Project of Nantong City Health Committee, No. MS2023027; and Young Medical Talents Fund of Health and Family Planning Commission of Nantong, No. QA2019006 and No. QNZ2023027.
Institutional review board statement: This retrospective and single-center study was approved by the Ethics Committee of Nantong First People’s Hospital (Approval No. 2025KT124).
Informed consent statement: Patient consent was waived owing to the retrospective nature of the study.
Conflict-of-interest statement: No financial or nonfinancial benefits have been received or will be received from any party directly or indirectly related to the subject of this article.
Data sharing statement: All data generated or analyzed during this study are available from the corresponding author Bo-sheng He upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo-Sheng He, MD, PhD, Department of Radiology, Nantong First People’s Hospital, Affiliated Hospital 2 of Nantong University, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. boshenghe@126.com
Received: June 11, 2025
Revised: July 6, 2025
Accepted: July 28, 2025
Published online: August 28, 2025
Processing time: 78 Days and 17.6 Hours
Abstract
BACKGROUND

Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer (CRC). Low-keV virtual monoenergetic images (VMIs) have been shown to enhance lesion conspicuity. This study aimed to assess the diagnostic value of dual-layer spectral computed tomography (CT)-derived VMIs, in combination with multiplanar reformation (MPR) and evaluation of peritumoral fat stranding (PFS), for improving the accuracy of T staging in CRC.

AIM

To assess the diagnostic performance of dual-layer spectral CT (DLSCT) VMIs, particularly at low energy levels, and their integration with personalized MPR for preoperative T staging of CRC.

METHODS

In this retrospective study, 157 patients with pathologically confirmed CRC (mean age: 63.5 ± 12.1 years) underwent DLSCT within 1 week before surgery. VMIs ranging from 40 keV to 70 keV (at 10 keV intervals) and conventional polyenergetic images (PEIs) were reconstructed. Objective image quality parameters, including image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), were quantified, alongside subjective image quality scores using a 5-point Likert scale. Interobserver agreement was evaluated using κ statistics. Taking histopathology as the reference standard, the diagnostic accuracy of T staging (T1-2 vs T3-4) was compared across PEIs and VMIs, both with and without MPR and PFS.

RESULTS

Low-keV VMIs (40-70 keV) demonstrated significantly higher SNR and CNR than PEIs (all P < 0.001). Notably, 40-keV VMIs achieved noise levels comparable to PEIs (8.17 ± 3.63 vs 8.53 ± 2.90; P = 0.673). Subjective image quality peaked at 40-50 keV VMIs (Likert scores 4.85-4.88 vs 3.97 for PEIs; P < 0.001), supported by excellent interobserver agreement (κ = 0.812-0.913). The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy (94.27%) compared to axial PEIs (70.7%), with a sensitivity and specificity of 83.87% and 96.83%, respectively (Youden index = 0.81; P < 0.05). While PFS enhanced staging accuracy on PEIs (up to 77.07% with MPR), it provided no significant additional benefit for VMIs.

CONCLUSION

DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR. These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.

Keywords: Colorectal cancer; Dual-layer spectral computed tomography; Multiplanar reformation; Peritumoral fat stranding; T staging; Virtual monoenergetic images

Core Tip: Accurate preoperative T staging is critical for guiding individualized therapeutic strategies in colorectal cancer (CRC). However, conventional computed tomography demonstrates limited diagnostic performance, with reported accuracies ranging from 60.6% to 89%. This study demonstrated that low-energy (40-50 keV) virtual monoenergetic images (VMIs), when combined with multiplanar reformation (MPR), could substantially improve T staging accuracy to as high as 94.27%. While peritumoral fat stranding further enhanced staging accuracy on polyenergetic images, MPR alone achieved an accuracy of 77.07%. These findings supported the incorporation of low-keV VMIs and MPR into routine preoperative imaging protocols to optimize CRC staging and management.