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This study aims to establish the optimal morphological criteria combined with SAA levels for evaluation of lymph node metastasis in colorectal cancer.Prospectively enrolled colorectal cancer patients from December 2007 to October 2009 were examined by abdominopelvic enhanced MSCT scan. If regional lymph nodes were visible, the maximal long-axis diameter (MLAD), and maximal short-axis diameter (MSAD) were recorded. In addition,preoperative plasma levels of SAA were examined to identify metastatic or inflammatory lymph nodes combined with MSCT image. Then the results from MSCT plus SAA and MSCT alone were compared to the pathological findings.One hundred and thirty-three patients were identified whose scans showed with regional lymph nodes. There was a significant difference on MSAD (P = 0.042), but not on MLAD (P > 0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with a sensitivity of 44.3%, specificity of 74.6% and accuracy of 58.6% respectively. MSAD (6 mm) combined with SAA (SAA > 5.2 mg/l = positive patient) led to a significantly greater diagnostic value in sensitivity (74.3%, P < 0.001) and accuracy (70.7%, P = 0.040) than MSAD (6 mm) alone, with a nosignificantly decreased specificity (66.7%, P > 0.05).Thispresent study recommended MSAD ≥ 6 mm as the optimum criterion combined with SAA forpreoperative N staging in colorectal cancer.