Virtual Monoenergetic Images for Diagnostic Assessment of Hypodense Lesions Within the Liver: Semiautomatic Estimation of Window Settings Using Linear Models

Objective The aim of the study was to establish the reference window settings for display of virtual monoenergetic images (VMIs) from spectral detector computed tomography when assessing hypodense liver lesions. Methods In patients with cysts (n = 24) or metastases (n = 26), objective (HU, signal-to-noise ratio [SNR]) and subjective (overall image quality, lesion conspicuity and noise) were assessed. Furthermore, 2 readers determined optimal window center/width (C/W) for conventional images (CIs) and VMIs of 40 to 120 keV. Center/width were modeled against HUliv with and without respect to the keV level (models A and B). Results Attenuation and SNR were significantly higher in low-keV VMIs and improved overall image quality and lesion conspicuity (P 0.05). Model B provided valid estimations of C/W, whereas model A was slightly less accurate. Conclusions The increase in attenuation and SNR on low-keV VMIs requires adjustment of C/W, and they can be estimated in dependency of HUliv using linear models. Reference values for standard display of VMIs of 40 to 120 keV are reported