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Virtual monoenergetic images (VMIs) ranging from 40 to 120\u00a0keV (20\u00a0keV increments) were evaluated to identify the optimal energy level based on tumor CT value, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). On the optimal VMI, spectral CT quantitative parameters were measured in the arterial, venous, and delay phases, and dynamic multiphase parameters were calculated. Patients from center 1 were randomly divided into a training cohort and an internal testing cohort at a 7:3 ratio. The nomogram model was developed using the training cohort and subsequently evaluated in the internal testing cohort and an independent external validation cohort from center 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      (1) The 60\u00a0keV VMI demonstrated superior image quality, showing significantly higher tumor CT value, SNR, and CNR compared with other monoenergetic images (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). (2) Compared with EMVI negative patients, positive patients exhibited significantly higher values of \u0394HU40\n                      <jats:sub>(delay\u2212arterial)<\/jats:sub>\n                      , \u0394HU60\n                      <jats:sub>(delay\u2212arterial)<\/jats:sub>\n                      , \u0394IC\n                      <jats:sub>(delay\u2212arterial)<\/jats:sub>\n                      , delay enhancement fraction (DEF), and \u0394Zeff\n                      <jats:sub>(venous\u2212arterial)<\/jats:sub>\n                      (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Multivariable analysis further identified these five parameters as independent predictors of EMVI. (3) A nomogram was constructed based on these parameters and demonstrated AUCs of 0.93, 0.91, and 0.84 in the training, testing, and external validation cohorts, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 60\u00a0keV VMI provides improved lesion delineation in colon cancer. A nomogram incorporating dynamic multiphase spectral CT parameters enables accurate preoperative prediction of EMVI and may support individualized clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40644-026-01098-6","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:08:30Z","timestamp":1785467310000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a nomogram for predicting extramural venous invasion in colon cancer using spectral CT multiparameter imaging"],"prefix":"10.1186","volume":"26","author":[{"given":"Wen","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaowu","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gangjing","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Rui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"1098_CR1","doi-asserted-by":"publisher","unstructured":"Roshandel G, Ghasemi-Kebria F, Malekzadeh R. 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