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Pfeiffer F, Willer K, Viermetz M, Pfeiffer D. [Dark-field imaging and computed tomography : Novel X-ray-based contrast imaging modality with great promise for pulmonary imaging]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01161-4. [PMID: 37341743 DOI: 10.1007/s00117-023-01161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The spatial and contrast resolution of conventional planar or computed tomographic X‑ray techniques is not sufficient to investigate microstructures of tissues. Dark-field imaging with X‑rays is an emerging technology that recently provided the first clinical results and makes diagnostic use of interactions of the beams with tissue due to their wave character. APPLICATION Dark-field imaging can provide information about the microscopic structure or porosity of the tissue under investigation that is otherwise inaccessible. This makes it a valuable complement to conventional X‑ray imaging, which can only account for attenuation. Our results demonstrate that X‑ray dark-field imaging provides pictorial information about the underlying microstructure of the lung in humans. Given the close relationship between alveolar structure and the functional state of the lung, this is of great importance for diagnosis and therapy monitoring and may contribute to a better understanding of lung diseases in the future. In the early detection of chronic obstructive pulmonary disease, which is usually associated with structural impairment of the lung, this novel technique could help to facilitate its diagnosis. PERSPECTIVE The application of dark-field imaging to computed tomography is still under development because it is technically difficult. Meanwhile, a prototype for experimental application has been developed and is currently being tested on a variety of materials. Use in humans is conceivable especially for tissues whose microstructure favors characteristic interactions due to the wave nature of the X‑rays.
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Affiliation(s)
- Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Deutschland.
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Deutschland.
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Deutschland.
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Deutschland
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Deutschland
| | - Manuel Viermetz
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Deutschland
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Deutschland
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Deutschland
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Deutschland
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Frank M, Gassert FT, Urban T, Willer K, Noichl W, Schick R, Schultheiss M, Viermetz M, Gleich B, De Marco F, Herzen J, Koehler T, Engel KJ, Renger B, Gassert FG, Sauter A, Fingerle AA, Haller B, Makowski MR, Pfeiffer D, Pfeiffer F. Dark-field chest X-ray imaging for the assessment of COVID-19-pneumonia. COMMUNICATIONS MEDICINE 2022; 2:147. [PMID: 36411311 PMCID: PMC9678896 DOI: 10.1038/s43856-022-00215-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Currently, alternative medical imaging methods for the assessment of pulmonary involvement in patients infected with COVID-19 are sought that combine a higher sensitivity than conventional (attenuation-based) chest radiography with a lower radiation dose than CT imaging. METHODS Sixty patients with COVID-19-associated lung changes in a CT scan and 40 subjects without pathologic lung changes visible in the CT scan were included (in total, 100, 59 male, mean age 58 ± 14 years). All patients gave written informed consent. We employed a clinical setup for grating-based dark-field chest radiography, obtaining both a dark-field and a conventional attenuation image in one image acquisition. Attenuation images alone, dark-field images alone, and both displayed simultaneously were assessed for the presence of COVID-19-associated lung changes on a scale from 1 to 6 (1 = surely not, 6 = surely) by four blinded radiologists. Statistical analysis was performed by evaluation of the area under the receiver-operator-characteristics curves (AUC) using Obuchowski's method with a 0.05 level of significance. RESULTS We show that dark-field imaging has a higher sensitivity for COVID-19-pneumonia than attenuation-based imaging and that the combination of both is superior to one imaging modality alone. Furthermore, a quantitative image analysis shows a significant reduction of dark-field signals for COVID-19-patients. CONCLUSIONS Dark-field imaging complements and improves conventional radiography for the visualisation and detection of COVID-19-pneumonia.
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Affiliation(s)
- Manuela Frank
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany.
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany.
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany.
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Theresa Urban
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Rafael Schick
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Manuel Schultheiss
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Manuel Viermetz
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Gleich
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Thomas Koehler
- Philips Research, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | | | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
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