Detecting hepatic lesions: The added utility of CT liver window settings

PURPOSE: To prospectively evaluate the utility of adding computed tomograph ic (CT) liver windows to conventional soft-tissue windows for the detection of hepatic disease. MATERIALS AND METHODS: One of four radiologists experienced in abdominal im aging interpreted 1,175 consecutive abdominal CT scans from one institution . Hepatic images were first interpreted by using standard soft-tissue windo ws. The number of lesions and confidence in lesion detection were recorded. The liver-window images were then interpreted in conjunction with the soft -tissue-window images, and the number of lesions and confidence in detectio n were recorded again. The proportion of patients in whom additional lesion s were found by using liver windows was determined. RESULTS: On soft-tissue-window and liver-window scans interpreted together, 869 (74%) patients had no hepatic lesions. Thirty-six (3.1%) patients had new lesions seen with the addition of liver windows. Twelve of these 36 pat ients had no lesions seen on soft-tissue-window scans. Twenty-six of the 36 patients with additional lesions seen had a history of neoplasm. There was a change in diagnosis in 1.7% of the patients with the addition of liver w indows and a change in recommendation for follow-up in 0.85%. CONCLUSION: Routine interpretation of liver-window scans for all abdominal CT scans has limited added utility in detecting hepatic disease.