First evidence of improved diagnostic accuracy in hypodense liver lesion differentiation with dual-energy CT versus conventional CT in colorectal cancer patients

This study assessed the capability of different CT-based parameters to differentiate hypodense liver lesions in patients with colorectal cancer. A retrospective cohort of 120 patients who underwent dual-energy CT for tumor staging was analyzed, focusing on conventional CT attenuation values, effective atomic number (Zeff), fat fraction (FF), and iodine concentration (IC). In total, 223 lesions including both metastases and cysts were examined, with biopsy or MRI serving as reference standards. While the CT, FF, and IC values of metastases and cysts differed significantly, Zeff showed limited discriminatory power. Among the parameters evaluated, FF demonstrated the highest diagnostic accuracy, achieving an area under the curve of 0.97 with excellent sensitivity and specificity at the established cut-off. The findings suggest that FF is the most robust marker for distinguishing metastatic from cystic liver lesions in colorectal cancer patients.