All examinations were performed on a single source CT scanner (Somatom Sensation 64, Siemens Healthcare Forchheim, Germany). To achieve Dual Energy CT (DECT) images, a scan-to-scan technique was used. Two sequential scans with 80 kVp and 140 kVp were acquired with adapted acquisition parameters to assure similar noise levels of both scans. The tube current–time products were 265 mAs (80 kVp) and 91 mAs (140 kVp), the exposure time 15.17 s, scan lengths 341 mm, pitch 0.6 mm, slice acquisition 64 × 0.6 mm. CT doses (DLP) were calculated to 24.87 mGycm (80 kVp) and 49.18 mGycm (140 kVp). There was no necessity for hard filtration. Acquisition FOV was 500 mm for both scans.

Standard iterative reconstruction (IR) (level 3, range 1–5) and a bone (sharp) kernel (Q70) were used for image reconstruction, with a slice thickness of 0.75 mm and an increment of 0.5 (image matrix 512 × 512). Postprocessing was performed with a monoenergetic application algorithm, which was proposed and installed on the scanner for routine use by the manufacturer (Siemens). Virtual monochromatic spectral (VMS) images were calculated at 40, 50, 70, 100, 120, 140 and 190 keV. The intervals between the 40 and 190 keV had been defined by the software and could not be arbitrarily varied. The two other datasets generated consisted of the originally acquired, polychromatic 80 kVp and 140 kVp images.

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