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Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography

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Abstract

Objectives

To define optimal window settings for displaying virtual monoenergetic images (VMI) of dual-energy CT pulmonary angiography (DE-CTPA).

Methods

Forty-five patients who underwent clinically-indicated third-generation dual-source DE-CTPA were retrospectively evaluated. Standard linearly-blended (M_0.6), 70-keV traditional VMI (M70), and 40-keV noise-optimised VMI (M40+) reconstructions were analysed. For M70 and M40+ datasets, the subjectively best window setting (width and level, B-W/L) was independently determined by two observers and subsequently related with pulmonary artery attenuation to calculate separate optimised values (O-W/L) using linear regression. Subjective evaluation of image quality (IQ) between W/L settings were assessed by two additional readers. Repeated measures of variance were performed to compare W/L settings and IQ indices between M_0.6, M70, and M40+.

Results

B-W/L and O-W/L for M70 were 460/140 and 450/140, and were 1100/380 and 1070/380 for M40+, respectively, differing from standard DE-CTPA W/L settings (450/100). Highest subjective scores were observed for M40+ regarding vascular contrast, embolism demarcation, and overall IQ (all p<0.001).

Conclusions

Application of O-W/L settings is beneficial to optimise subjective IQ of VMI reconstructions of DE-CTPA. A width slightly less than two times the pulmonary trunk attenuation and a level approximately of overall pulmonary vessel attenuation are recommended.

Key Points

• Application of standard window settings for VMI results in inferior image perception.

• No significant differences between B-W/L and O-W/L for M70/M40+ were observed.

• O-W/L for M70 were 450/140 and were 1070/380 for M40+.

• Improved subjective IQ characteristics were observed for VMI displayed with O-W/L.

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Tommaso D’Angelo and Andreas M. Bucher contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Tommaso D’Angelo, Andreas M. Bucher, Lukas Lenga, Christophe T. Arendt, Julia L. Peterke, Simon S. Martin, Doris Leithner, Thomas J. Vogl & Julian L. Wichmann

  2. Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Via Consolare Valeria 1, 98100, Messina, Italy

    Tommaso D’Angelo, Silvio Mazziotti, Alfredo Blandino & Giorgio Ascenti

  3. Department of Radiological Sciences, Oncological and Pathological Sciences, “La Sapienza” University Hospital, Latina, Italy

    Damiano Caruso

  4. Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tübingen, Tübingen, Germany

    Ahmed E. Othman

Authors
  1. Tommaso D’Angelo
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  2. Andreas M. Bucher
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  3. Lukas Lenga
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  8. Alfredo Blandino
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  9. Giorgio Ascenti
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  11. Simon S. Martin
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  12. Doris Leithner
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  13. Thomas J. Vogl
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  14. Julian L. Wichmann
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Corresponding author

Correspondence to Julian L. Wichmann.

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Guarantor

The scientific guarantor of this publication is Julian L. Wichmann.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: J.L.W. received speakers’ fees from GE Healthcare and Siemens Healthcare. The other authors have no conflict of interest to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

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• performed at one institution

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D’Angelo, T., Bucher, A.M., Lenga, L. et al. Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography. Eur Radiol 28, 1393–1401 (2018). https://doi.org/10.1007/s00330-017-5059-6

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  • DOI: https://doi.org/10.1007/s00330-017-5059-6

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