Assessment of Spectral Computed Tomography Image Quality and Detection of Lesions in the Liver Based on Image Reconstruction Algorithms and Virtual Tube Voltage

<b>Background</b>: Spectral detector computed tomography (SDCT) has demonstrated superior diagnostic performance and image quality in liver disease assessment compared with traditional CT. Selecting the right reconstruction algorithm and tube voltage is essential to avoid increased noise and diagnostic errors. <b>Objectives</b>: This study evaluated improvements in image quality achieved using various virtual tube voltages and reconstruction algorithms for diagnosing common liver diseases with spectral CT. <b>Methods</b>: This retrospective study involved forty-seven patients who underwent spectral CT scans for liver conditions, including fatty liver, hemangiomas, and metastatic lesions. The assessment utilized signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), with images reconstructed using various algorithms (IMR, iDose) at different levels and virtual tube voltages. Three experienced radiologists analyzed the reconstructed images to identify the best reconstruction methods and tube voltage combinations for diagnosing these liver pathologies. <b>Results</b>: The signal-to-noise ratio (SNR) was highest for spectral CT images using the IMR3 algorithm in metastatic, hemangioma, and fatty liver cases. A strong positive correlation was found between IMR3 at 120 keV and 70 keV (<i>p</i>-value = 0.000). In contrast, iDOSE2 at 120 keV and 70 keV showed a low correlation of 0.291 (<i>p</i>-value = 0.045). Evaluators noted that IMR1 at 70 keV provided the best visibility for liver lesions (mean = 3.58), while IMR3 at 120 keV had the lowest image quality (mean = 2.65). <b>Conclusions</b>: Improvements in image quality were noted with SDCT, especially in SNR values for liver tissues at low radiation doses and a specific IMR level. The IMR1 algorithm reduced noise, enhancing the visibility of liver lesions for better diagnosis.