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PURPOSE To assess the utility of single source-dual energy CT for distinguishing bladder cancer from hematoma. METHOD AND MATERIALS We retrospectively identified14 postoperative or follow-up bladder hematoma patients who had undergone dual energy protocol(40-140kev)scanning by single source-dual energy CT from Nov. 2011 to Jan. 2015. The subjective scoring of tumor detection and image quality of all images, the optimal monochrome images and iodine-water images were graded by two radiologists who didnt know the results. The consistency of two observer was analysed by using Kappa test. Mann-Whitney U test was used to compare the difference between the two diseases and ROC curve was used to analyse the diagnostic eff1ciency. The statistical difference of image quality scoring among different images by using Mann-Whitney U test. RESULTS The consistency of the two observers about scoring of lesion detection were good in all groups. There were statistical difference between two groups in non-enhanced phase, arterial phase of quality control images, non-enhanced phase, arterial phase, delayed phase of optimal monochromatic images and all phase of iodine-water images. The AUC of iodine-water images in the four phases(0.985,1.0,0.955,0.924,respectively)were all higher than that of polychrome unenhanced and arterial phase images(0.909、 0.909). The diagnosis efficiency of arterial phase iodine-water images was the highest. Sensitivity and specificity is both100%when score is greater than2.5. There was no statistical difference between two diseases of non-enhanced phase, delayed phases quality control images(P>0.05). There were no statistical differences in image quality scoring among the three groups with the same phases(P>0.05). CONCLUSION Optimal monoghromatic images and iodine-water images of single source-dual energy CT are more effective than conventional CT in distinguishing bladder cancer from hematoma.