Early rectal neoplasm in dual-layer spectral detector computed tomography: dual-layer spectral computed tomography (CT) images improve tumor detection and staging

Background: Early rectal neoplasms can be treated endoscopically with good prognosis, yet usually present with unspecific or an absence of signs and symptoms and are detected largely by invasive endoscopy with less compliance to screening. The purpose of this cross-sectional study was to explore the diagnostic value of dual-layer spectral detector computed tomography (DSCT) imaging for early rectal neoplasm.<br /> Methods: Patients who underwent DSCT for evaluation of rectal lesion or routine examination between September 2022 to September 2023 at West China Hospital were prospectively included and identified as group A (control, n=76), group B (rectal advanced adenomas and <= T1 rectal cancer, n=59), and group C (>= T2 staging rectal cancer, n=74). Lesion visualization was graded to assess image quality. Spectral quantitative measurement, such as Hounsfield unit (HU)40 keV, HU70 keV, iodine concentration (IC), effective atomic number (Zeff), and the slope of spectral curve (lambda), was analyzed and compared. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic efficacy of spectral parameters. A comparison of ROC curves was applied to test the significance of differences between the area under the<br /> Results: Compared to poly-energetic images (PEIs), the multiple parameters from DSCT were of greater capability to recognize rectal lesions. There were significant differences in HU40 keV (208.01 +/- 43.60 vs. 8.50) vs. 8.61 +/- 0.20], and lambda [3.80 (3.41, 4.52) vs. 5.16 +/- 1.00] between the early neoplastic lesions in rectum and the advanced rectal cancer (P<0.001). Significant correlations were found between the DSCT parameters rectal neoplasm detection, with additional capability of discriminating early rectal neoplasm from advanced rectal cancer.<br /> Conclusions: DSCT improved tumor conspicuity and the detection of the early rectal neoplastic lesion, suggesting that it is a promising screening tool in clinical practice.