Daud Marron, Goldberg S Nahum, Cohen Dotan, Dar Gili, Levy Shiran, Nevo Adam, Sosna Jacob, Lev-Cohain Naama
Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Isr Med Assoc J. 2025 May;27(5):283-289.
Coronavirus disease-2019 (COVID-19) chest computed tomography (CT) involves ground-glass opacity (GGO) and denser consolidations, which are crucial for diagnosis.
To determine optimal window settings for characterization and detection of GGO and dense consolidation on CT imaging in COVID-19 patients using a Simplex-based approach.
The study included 54 conventional CTs of COVID patients in two phases. First, CT images of 14 patients with GGO and 4 with dense consolidation were included. Seven radiologists evaluated representative images in different windows of varied width and center. They were graded for adequacy of characterization and detection. A Simplex algorithm was used to iteratively determine the optimal window settings. Surface response maps expressing the relationship between window settings and overall reader grades were constructed. Next, the reviewers compared manufacturer recommendations to the new optimal windows found on CT images of 40 patients.
Overall, 12 different window settings were evaluated over a total of 1176 reads. Optimal characterization and detection of pure GGO was seen with a center of 630 HU and width 1460 HU, producing higher grades for both detection and characterization than the manufacturer window settings (P = 0.005). Optimal windowing for dense consolidation was like manufacturer measures (-585 HU and 1800 HU). In phase 2, an overwhelming preference of 78% favoring the optimal window compared to conventional settings was found.
GGO lung opacities characteristic for COVID-19 can be best seen using a lower CT windowing width than the manufacturer's recommendations, unlike denser consolidations, possibly due to differences in underlying pathophysiology.
2019冠状病毒病（COVID-19）胸部计算机断层扫描（CT）表现为磨玻璃影（GGO）和更致密的实变影，这些对诊断至关重要。
采用基于单纯形法的方法确定COVID-19患者CT成像中GGO和致密实变影的特征描述及检测的最佳窗宽设置。
该研究分两个阶段纳入了54例COVID患者的常规CT。首先，纳入14例有GGO和4例有致密实变影患者的CT图像。7名放射科医生评估了不同宽度和中心的不同窗宽下的代表性图像。对其特征描述和检测的充分性进行分级。使用单纯形算法迭代确定最佳窗宽设置。构建了表示窗宽设置与总体阅片者评分之间关系的表面响应图。接下来，阅片者将制造商推荐的窗宽与在40例患者CT图像上发现的新的最佳窗宽进行比较。
总体而言，在总共1176次阅片中评估了12种不同的窗宽设置。对于单纯GGO，中心值为630 HU、宽度为1460 HU时可实现最佳的特征描述和检测，其检测和特征描述的评分均高于制造商推荐的窗宽设置（P = 0.005）。致密实变影的最佳窗宽与制造商推荐的测量值相似（-585 HU和1800 HU）。在第二阶段，发现与传统设置相比，78%的人压倒性地更倾向于最佳窗宽。
与致密实变影不同，COVID-19特有的GGO肺实变影使用比制造商推荐值更低的CT窗宽能看得最清楚，这可能是由于潜在病理生理学的差异。
