{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:04:43Z","timestamp":1787029483245,"version":"build-2736575974"},"reference-count":12,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Bladder neoplasms often present with coexisting thrombi and hematuria, appearing as complex intraluminal masses on imaging, and posing a key diagnostic challenge in distinguishing neoplastic tissue from thrombus, to prevent harmful overstaging. Case Presentation: An 82-year-old man with recurrent gross hematuria and urinary disturbances was evaluated by ultrasound, which identified a large endoluminal lesion in the anterior bladder wall. The patient subsequently underwent contrast-enhanced CT using a second-generation dual-layer spectral CT system, which utilizes a dual-layer detector to simultaneously acquire high- and low-energy X-ray data. Conventional CT images confirmed a multifocal, bulky hyperdense lesion along the bladder wall, protruding into the lumen and raising suspicion for a heterogeneous mass, though further characterization was not possible. Spectral imaging enabled the reconstruction of additional maps\u2014such as iodine density, effective atomic number (Z-effective), and electron density\u2014which were used to further characterize these findings. The combination of these techniques clearly demonstrated differences in iodine uptake and tissue composition within the parietal lesions, allowing for a reliable differentiation between neoplastic tissue and intraluminal thrombus. Conclusions: The integration of conventional CT imaging with spectral-derived maps generated in post-processing allowed for accurate and reliable tissue differentiation between bladder neoplasm and thrombus. Spectral imaging holds the potential to prevent tumor overstaging, thereby supporting more appropriate clinical management. The dual-layer technology enables the generation of these maps from every acquisition without altering the scan protocol, thereby having minimal impact on the daily clinical workflow.<\/jats:p>","DOI":"10.3390\/reports8030186","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T08:37:39Z","timestamp":1758530259000},"page":"186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dual-Layer Spectral CT for Advanced Tissue Characterization: Differentiating Bladder Neoplasm from Intraluminal Thrombus\u2014A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Bianca","family":"Catalano","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Psychology, Sant\u2019Andrea University Hospital, Sapienza-University of Rome, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-4764","authenticated-orcid":false,"given":"Damiano","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit-Sant\u2019Andrea University Hospital, Sapienza-University of Rome, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6484-9765","authenticated-orcid":false,"given":"Giuseppe","family":"Tremamunno","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit-Sant\u2019Andrea University Hospital, Sapienza-University of Rome, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S1040-8428(01)00128-7","article-title":"Bladder Cancer","volume":"41","author":"Maffezzini","year":"2002","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s41572-023-00468-9","article-title":"Bladder Cancer","volume":"9","author":"Hansel","year":"2023","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.hoc.2021.02.004","article-title":"Diagnosis and Staging of Bladder Cancer","volume":"35","author":"Ahmadi","year":"2021","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/JU.0000000000003846","article-title":"Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA\/SUO Guideline: 2024 Amendment","volume":"211","author":"Holzbeierlein","year":"2024","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s11547-022-01488-3","article-title":"CT-Urography: A Nationwide Survey by the Italian Board of Urogenital Radiology","volume":"127","author":"Ascenti","year":"2022","journal-title":"Radiol. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3390\/tomography10030024","article-title":"Dual-Energy CT in Oncologic Imaging","volume":"10","author":"Foti","year":"2024","journal-title":"Tomography"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.diii.2022.11.003","article-title":"Spectral CT Imaging: Technical Principles of Dual-Energy CT and Multi-Energy Photon-Counting CT","volume":"104","author":"Greffier","year":"2023","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"592","DOI":"10.21037\/qims.2020.02.17","article-title":"The Optimal Monoenergetic Spectral Image Level of Coronary Computed Tomography (CT) Angiography on a Dual-Layer Spectral Detector CT with Half-Dose Contrast Media","volume":"10","author":"Huang","year":"2020","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"World Medical Association (2025). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA, 333, 71\u201374.","DOI":"10.1001\/jama.2024.21972"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13244-024-01881-8","article-title":"Diagnostic Value of Dual-Layer Spectral Detector CT Parameters for Differentiating High- from Low-Grade Bladder Cancer","volume":"16","author":"Chen","year":"2025","journal-title":"Insights Into Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/jmri.27090","article-title":"MRI of Bladder Cancer: Local and Nodal Staging","volume":"52","author":"Caglic","year":"2020","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.urolonc.2022.05.017","article-title":"The Increasing Indications of FDG-PET\/CT in the Staging and Management of Invasive Bladder Cancer","volume":"40","author":"Omorphos","year":"2022","journal-title":"Urol. Oncol."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/186\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:26Z","timestamp":1760035586000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,20]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["reports8030186"],"URL":"https:\/\/doi.org\/10.3390\/reports8030186","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,20]]}}}