A Simplex algorithm approach to determine the optimal keV and window setting for appendicitis visualization

Area of Science:

• Radiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Contrast-enhanced dual-energy CT (DECT) aids in visualizing acute inflammatory processes.
• High iodine attenuation in DECT necessitates window display adjustments for optimal interpretation.

Purpose of the Study:

• To determine optimal keV and window settings for visualizing acute appendicitis using low-mono-energetic DECT.
• To enhance the conspicuity of appendicitis on CT scans.

Main Methods:

• Retrospective analysis of 34 appendicitis patients using DECT.
• Iterative optimization algorithm to identify optimal keV (40-70 keV) and window parameters.
• Radiologist evaluation of appendix wall enhancement and image quality across 14 keV and window settings.

Main Results:

• Optimal window settings for 40 keV were identified as 57-79 HU center and 357-418 HU width.
• Highest conspicuity grade (4.4 ± 0.0) achieved at 40 keV with specific window settings.
• Algorithmic optimization led to improved visualization of inflammatory processes.

Conclusions:

• Algorithmic optimization of DECT parameters can significantly improve visualization of acute appendicitis.
• Tailoring keV levels and window settings enhances mucosal enhancement and diagnostic accuracy.
• This approach aids in the interpretation of acute inflammatory conditions.