Stearns J, McLaughlin S, Kuckelman T, Hutzley S, Chiu A, Kloft L, Bay C, Kundranda M, Chang J. Colorectal cancer computed tomography imaging features involving microsatellite instability. World J Clin Oncol 2026; 17(3): 114756 [DOI: 10.5306/wjco.v17.i3.114756]
Corresponding Author of This Article
John Chang, MD, PhD, Department of Radiology, Banner MD Anderson Cancer Center, 2940 E. Banner Gateway Drive, Suite 315, Gilbert, AZ 85234, United States. changresearch1@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Mar 24, 2026; 17(3): 114756 Published online Mar 24, 2026. doi: 10.5306/wjco.v17.i3.114756
Colorectal cancer computed tomography imaging features involving microsatellite instability
Jack Stearns, Scott McLaughlin, Tristan Kuckelman, Samantha Hutzley, Albert Chiu, Luke Kloft, Curtis Bay, Madappa Kundranda, John Chang
Jack Stearns, College of Medicine, University of Arizona, Phoenix, AZ 85004, United States
Scott McLaughlin, Tristan Kuckelman, Samantha Hutzley, Albert Chiu, Luke Kloft, School of Osteopathic Medicine in Arizona, A.T. Still University of Health Sciences, Mesa, AZ 85206, United States
Curtis Bay, Department of Interdisciplinary Sciences, A.T. Still University, Mesa, AZ 85206, United States
Madappa Kundranda, Division of Cancer Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ 85234, United States
John Chang, Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, AZ 85234, United States
Co-first authors: Jack Stearns and Scott McLaughlin.
Author contributions: Stearns J, McLaughlin S, Kuckelman T, Hutzley S, Chiu A, and Kloft L collected and analyzed the data as well as drafting the manuscript for publication; Stearns J and McLaughlin S worked extensively on manuscript preparation, and they contributed equally to this manuscript as co-first authors; Bay C performed the statistical analysis of the data and consulted on data interpretation; Kundranda M consulted clinical relevance and revised the manuscript; Chang J designed the experiment, revised the manuscript, and oversaw the execution of the research project. All authors have read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by Banner Health Institutional Review Board (approved No. 14-16-0047).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement:
No additional data are available.
Corresponding author: John Chang, MD, PhD, Department of Radiology, Banner MD Anderson Cancer Center, 2940 E. Banner Gateway Drive, Suite 315, Gilbert, AZ 85234, United States. changresearch1@gmail.com
Received: October 11, 2025 Revised: December 3, 2025 Accepted: February 2, 2026 Published online: March 24, 2026 Processing time: 172 Days and 10.5 Hours
Abstract
BACKGROUND
Microsatellite instability (MSI) of colorectal cancer (CRC) is an important biomarker for treatment response to immune checkpoint inhibitor therapy. Traditionally, this has been identified using histological methods, but more recently, radiomics techniques have been applied to computed tomography (CT) images showing ability to differentiate MSI tumors. However, the variable techniques and scanner noise may limit broad application of the technique. Identifying visible, macroscopic imaging features may present a more invariant technique to identify MSI tumors on imaging.
AIM
To identify CT-based imaging features without radiomics to differentiate between MSI status in CRC.
METHODS
Imaging features of 109 subjects (58 male, 51 female) from 2011 to 2018 were stratified based on MSI status using CT scan images and pathological records. These variables included primary tumor location, primary tumor size, initial cancer stage, metastatic locations, primary attenuation compared to the liver, primary tumor growth pattern, primary tumor content, tumor margin, tumor density, and the presence or absence of mesenteric infiltration for primary tumor. Statistical analysis was performed using χ2, t tests, and Mann-Whitney U tests.
RESULTS
Four clinical characteristics were statistically significant for MSI-high (MSI-H). Although the MSI-H mass is larger (P < 0.001), the MSI-H tumors have a lower cancer stage at initial diagnosis (P = 0.012) as the MSI-H CRC tends to have regional metastasis than distant metastasis (P < 0.001). MSI-H CRC tends to be right-sided while MSI-low CRC tends to be left-sided (P < 0.001). The Hounsfield unit SD was lower in the MSI-H than the MSI-low CRC, P = 0.002. The remaining primary imaging characteristics (tumor attenuation relative to the liver, tumor content, tumor growth pattern, and tumor margin) were not statistically different. Both classes of tumors were more likely to be well-defined with mucosal growth and hypoattenuating relative to the liver on portovenous phase imaging.
CONCLUSION
Four clinical and one imaging characteristics were statistically significant for MSI-H CRC tumors. Larger and prospective trials would be needed to assess clinical applicability of these findings.
Core Tip: Microsatellite instability in colorectal tumors tends to have right-sided and larger tumor and is less likely to have distant metastasis at the time of initial diagnosis. Therefore, if a left-sided cancer with distant metastasis is seen at initial diagnosis, it has a higher likelihood of being a microsatellite instability low tumor.
