Tube voltage shifts CT liver attenuation values — but adjusted cutoffs restore steatosis classification accuracy

Tube voltage significantly affects CT attenuation-based hepatic steatosis measurements: 120-kVp-equivalent vs. 80-kVp images showed r = 0.921–0.975, but regression-adjusted values agreed excellently (ICC 0.966–0.992, mean difference ≤0.7 HU), enabling reliable cross-kVp steatosi…

• Single-center retrospective study; 795 adults underwent both liver CT and MR spectroscopy proton-density fat fraction (MRS-PDFF) as reference standard; cohort split into DECT (n=398) and SECT (n=397) arms with internal derivation/validation split.
• When tube voltage-specific cutoffs were applied to paired DECT data, sensitivity and specificity for hepatic steatosis (MRS-PDFF ≥5%) were comparable between 120-kVp-equivalent and 80-kVp images — exact sensitivity/specificity values not reported in source.
• Key limitation: single-center, retrospective design limits generalizability; cutoffs were derived and validated internally and require external validation across different CT vendors and patient populations.

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