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Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14\u00a0days were included. Two independent observers, blinded to the reference, performed two scorings. First, the conventional CT was scored and the results were recorded. Subsequently, Calcium suppression, monoenergetic (monoE40 and monoE200), and Z-effective reconstructions were added. Subjective visibility was compared to conventional CT using a 5-point Likert scale. Diagnostic accuracy measures were calculated with 95% confidence intervals. Sensitivity and specificity were compared using the McNemar\u2019s test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fourteen patients (63\u2009\u00b1\u20098\u00a0years; 64.3% female) and 189 vertebrae were included, with 46 vertebrae showing 58 metastases with a mean diameter of 18\u00a0mm (range 5\u201353\u00a0mm). For conventional CT, the sensitivity, specificity, and diagnostic accuracy for observer A and B were, respectively, 57% and 57%, 96% and 90%, 85% and 81%. The diagnostic performance did not improve when using the dual-layer CT reconstructions in addition to conventional CT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2265\u20090.13). MonoE40 improved the subjective visibility of metastases. Interobserver agreement was moderate for conventional CT (\u0138:0.48), and dual-layer CT reconstructions (\u0138:0.41\u20130.51).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dual-layer CT reconstructions did not improve diagnostic accuracy for osteolytic vertebral metastases compared with conventional CT, although subjective visibility was improved on low monoenergetic reconstructions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00256-025-05023-z","type":"journal-article","created":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T03:18:14Z","timestamp":1757128694000},"page":"329-339","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic accuracy of dual-layer spectral CT for osteolytic vertebral metastases"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3596-4195","authenticated-orcid":false,"given":"Simone","family":"van der Star","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Netanja I.","family":"Harlianto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie V.","family":"de Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorrit-Jan","family":"Verlaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold M. 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A waiver of written informed consent was obtained for this retrospective study (Vidatum reference number 22U-0073).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"SvdS, PdJ: The department of Radiology of the UMC Utrecht receives research support for spectral CT research. JJV and NIH receive support from the European Union, HEU topic HLTH-2022\u201312-01: \u2018METASTRA\u2019 project grant 101080135), outside of the submitted work. JJV is cofounder and stock-owner of SentryX. The other authors have nothing to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}