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22.03.2019 | Gastrointestinal | Ausgabe 7/2019

European Radiology 7/2019

The value of single-source dual-energy CT imaging for discriminating microsatellite instability from microsatellite stability human colorectal cancer

European Radiology > Ausgabe 7/2019
Jingjun Wu, Yue Lv, Nan Wang, Ying Zhao, Pengxin Zhang, Yijun Liu, Anliang Chen, Jianying Li, Xin Li, Yan Guo, Tingfan Wu, Ailian Liu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00330-019-06144-5) contains supplementary material, which is available to authorized users.
Jingjun Wu and Yue Lv contributed equally to this work.

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To demonstrate the value of single-source dual-energy computed tomography (ssDECT) imaging for discriminating microsatellite instability (MSI) from microsatellite stability (MSS) colorectal cancer (CRC).


Thirty-eight and seventy-six patients with pathologically proven MSI and MSS CRC, respectively, were retrospectively selected and compared. These patients underwent contrast-enhanced abdominal ssDECT scans before any anti-cancer treatment. Effective atomic number (Eff-Z) in precontrast phase, slope k of spectral HU curve in precontrast (k-P), arterial (k-A), venous (k-V), and delayed phase (k-D), normalized iodine concentration in arterial (NIC-A), venous (NIC-V), and delayed phase (NIC-D), of tumors in two groups were measured by two reviewers. Consistency of measurements was tested by intra-class correlation coefficients (ICC). Mann-Whitney U test or Student’s t test was used to compare above values between MSI and MSS. Multivariate logistic regression was used to analyze multiple parameters. Receiver operating characteristic curves were calculated to assess diagnostic efficacies.


Interobserver agreement was excellent (ICC > 0.80). MSI CRC had significantly lower values in all measurements (NIC-A, V, D; k-P, A, V, D; Eff-Z) than MSS CRC. For discriminating MSI from MSS CRC, the area under curve (AUC) using k-A was the highest (AUC, 0.803; sensitivity, 72.4%; specificity, 76.3%). The multivariate logistic regression (selection method, Enter) with combined ssDECT parameters (NIC-A, NIC-V, NIC-D, Eff-Z, k-P, k-A, k-V, k-D) significantly improved diagnostic capability with AUC of 0.886 (sensitivity, 81.6%; specificity, 81.6%).


The combination of multiple parameters in ssDECT imaging by multivariate logistic regression provides relatively high diagnostic accuracy for discriminating MSI from MSS CRC.

Key Points

ssDECT generates multiple parameters for discriminating CRC with MSI from MSS.
ssDECT measurements for MSI CRC were significantly lower than MSS CRC.
Combination of ssDECT parameters further improves diagnostic capability for differentiation.

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