Optimal CT windowing on low-monoenergetic images using a simplex algorithm-based approach for abdominal inflammatory processes

Gili Dar; S Nahum Goldberg; Shiran Levy; Adam Nevo; Marron Daud; Jacob Sosna; Naama Lev-Cohain

doi:10.1016/j.ejrad.2023.111262

Optimal CT windowing on low-monoenergetic images using a simplex algorithm-based approach for abdominal inflammatory processes

Eur J Radiol. 2024 Jan:170:111262. doi: 10.1016/j.ejrad.2023.111262. Epub 2023 Dec 14.

Authors

Gili Dar¹, S Nahum Goldberg¹, Shiran Levy¹, Adam Nevo¹, Marron Daud¹, Jacob Sosna¹, Naama Lev-Cohain²

Affiliations

¹ Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel.
² Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel. Electronic address: naamal@hadassah.org.il.

PMID: 38141262
DOI: 10.1016/j.ejrad.2023.111262

Abstract

Background: OBJECTIVES: To determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy spectral CT (DECT).

Methods: A retrospective study of 30 patients with clinically proven pancreatitis (15/30) or pyelonephritis (15/30) with inflammatory lesions visible on DECT scans were selected to serve as reference populations. 50 keV low-monoenergetic images in the portal venous phase were iteratively evaluated by 6 abdominal radiologists in twenty-one different windows (7-350HU center; 120-580HU width), selected using a simplex optimization algorithm. Each reader graded the conspicuity of the parenchymal hypodense lesions and image background quality. Three-dimensional contour maps expressing the relationship between overall reader grade and window center and width were constructed and used to find the ideal window for inflammatory pancreatic and renal processes and the image background quality. Finally, 15 appendicitis cases were reviewed on optimal pancreas and kidney windows and the manufacturer recommended conventional abdominal window settings for conventional imaging.

Results: Convergence to optimal windowing was achieved based upon a total of 3,780 reads (21 window settings × 6 readers × 15 cases for pancreas and kidney). Highest conspicuity grade (>4.5 ± 0.0) for pancreas inflammatory lesions was seen at 116HU/430HU, whereas hypodense pyelonephritis had highest conspicuity at 290HU/570HU. This rendered an ideal "compromise" window (>4 ± 0.2) of 150HU/450HU which differed substantially from conventional manufacturer recommended settings of 50HU/380HU (2.1 ± 1.0, p = 0.00001). Appendix mucosal enhancement was best visualized at manufacturer settings.

Conclusions: Optimal visualization of inflammatory processes in abdominal organs on 50 keV low-monoenergetic images may require tailored refinement of window settings.

Keywords: Appendicitis; Dual energy CT; Low-monoenrgetic; Pancreatitis; Pyelonephritis.

MeSH terms

Algorithms
Humans
Pyelonephritis*
Radiographic Image Interpretation, Computer-Assisted
Radiography, Dual-Energy Scanned Projection* / methods
Retrospective Studies
Signal-To-Noise Ratio
Tomography, X-Ray Computed / methods