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Grunz JP, Kunz AS, Paul MM, Luetkens KS, Huflage H, Conrads N, Ergün S, Weber T, Herbst M, Herold S, Bley TA, Patzer TS. Postoperative Extremity Tomosynthesis-A Superimposition-Free Alternative to Standard Radiography? Invest Radiol 2024:00004424-990000000-00215. [PMID: 38709665 DOI: 10.1097/rli.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
RATIONALE AND OBJECTIVES This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms. MATERIALS AND METHODS After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement. RESULTS Radiation dose in radiography was 0.48 ± 0.26 dGy·cm2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms (P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols (P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis (P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598-0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599-0.903), implant positioning (ICC, 0.855; 95% CI, 0.729-0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556-0.934). CONCLUSIONS In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.
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Affiliation(s)
- Jan-Peter Grunz
- From the Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany (J.-P.G., A.S.K., K.S.L., H.H., N.C., T.A.B., T.S.P.); Department of Orthopedic Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany (M.M.P.); Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany (S.E.); and X-ray Products-Research and Development, Siemens Healthineers AG, Forchheim, Germany (T.W., M.H., S.H.)
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Patzer TS, Kunz AS, Huflage H, Conrads N, Luetkens KS, Pannenbecker P, Ergün S, Herbst M, Herold S, Weber T, Bley TA, Grunz JP. Tomosynthesis of the Appendicular Skeleton on a Twin Robotic X-ray System: A Cadaveric Fracture Study. Acad Radiol 2024:S1076-6332(24)00090-4. [PMID: 38448327 DOI: 10.1016/j.acra.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
RATIONALE AND OBJECTIVES Aiming to offset image quality limitations in radiographs due to superimposition, this study investigates the diagnostic potential of appendicular skeleton tomosynthesis. MATERIALS AND METHODS Eight cadaveric extremities (four hands and feet) were examined employing the prototypical tomosynthesis mode of a twin robotic X-ray scanner. 12 protocols with varying sweep angles (10, 20 vs. 40°), frame rates (13 vs. 26 fps), and tube voltages (60 vs. 80 kV) were compared to radiographs. Four radiologists separately evaluated cortical and trabecular bone visualization and fracture patterns. Interreader reliability was assessed based on the intraclass correlation coefficient (ICC). RESULTS Radiation dose in radiography was 0.59 ± 0.20 dGy * cm2 versus 0.11 ± 0.00 to 2.46 ± 0.17 dGy * cm2 for tomosynthesis. Cortical bone display was inferior for radiographs compared to 40° and 20° tomosynthesis. Best results were ascertained for the 80 kV/40°/26 fps protocol. Trabecular bone depiction was also superior in tomosynthesis (p ≤ 0.009) and best with the 80 kV/10°/26 fps setting. Interreader reliability was moderate for cortical bone display (ICC 0.521, 95% confidence interval 0.356-0.641) and good for trabecular bone (0.759, 0.697-0.810). Diagnostic accuracy for articular involvement and multifragment situations was higher in tomosynthesis (93.8-100%/92.2-100%) vs. radiography (85.9%/82.8%.). Diagnostic confidence was also better in tomosynthesis (p ≤ 0.003). CONCLUSION Compared to radiography, tomosynthesis allows for superior assessability of cortical and trabecular bone and fracture morphology, especially at high framerates. Operating on a multipurpose X-ray system, tomosynthesis of the appendicular skeleton can be performed without additional scanner hardware.
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Affiliation(s)
- Theresa Sophie Patzer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany
| | - Magdalena Herbst
- X-ray Products - Research & Development, Siemens Healthineers AG, Siemensstraße 3, 91301 Forchheim, Germany
| | - Sophia Herold
- X-ray Products - Research & Development, Siemens Healthineers AG, Siemensstraße 3, 91301 Forchheim, Germany
| | - Thomas Weber
- X-ray Products - Research & Development, Siemens Healthineers AG, Siemensstraße 3, 91301 Forchheim, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study. Diagnostics (Basel) 2021; 11:diagnostics11112094. [PMID: 34829440 PMCID: PMC8623614 DOI: 10.3390/diagnostics11112094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.
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Stewart HL, Kawcak CE, Inscoe CR, Puett C, Lee YZ, Lu J, Zhou OZ, Selberg KT. Comparative evaluation of tomosynthesis, computed tomography, and magnetic resonance imaging findings for metacarpophalangeal joints from equine cadavers. Am J Vet Res 2021; 82:872-879. [PMID: 34669497 DOI: 10.2460/ajvr.82.11.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers; compare the tomosynthesis appearance of pathological lesions with their conventional radiographic, CT, and MRI appearances; and evaluate all imaging findings with gross lesions of a given MCPJ. SAMPLE Distal portions of 4 forelimbs from 4 equine cadavers. PROCEDURES The MCPJs underwent radiography, tomosynthesis (with a purpose-built benchtop unit), CT, and MRI; thereafter, MCPJs were disarticulated and evaluated for the presence of gross lesions. The ability to identify pathological lesions on all images was assessed, followed by semiobjective scoring for quality of the overall image and appearance of the subchondral bone, articular cartilage, periarticular margins, and adjacent trabecular bone of the third metacarpal bone, proximal phalanx, and proximal sesamoid bones of each MCPJ. RESULTS Some pathological lesions in the subchondral bone of the third metacarpal bone were detectable with tomosynthesis but not with radiography. Overall, tomosynthesis was comparable to radiography, but volumetric imaging modalities were superior to tomosynthesis and radiography for imaging of subchondral bone, articular cartilage, periarticular margins, and adjacent bone. CONCLUSIONS AND CLINICAL RELEVANCE With regard to the diagnostic characterization of equine MCPJs, tomosynthesis may be more accurate than radiography for identification of lesions within subchondral bone because, in part, of its ability to reduce superimposition of regional anatomic features. Tomosynthesis may be useful as an adjunctive imaging technique, highlighting subtle lesions within bone, compared with standard radiographic findings.
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Affiliation(s)
- Holly L Stewart
- From the Equine Orthopaedic Research Center and Translational Medicine Institute, Department of Clinical Sciences, and Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
| | - Christopher E Kawcak
- From the Equine Orthopaedic Research Center and Translational Medicine Institute, Department of Clinical Sciences, and Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
| | - Christina R Inscoe
- Department of Physics and Astronomy, College of Arts and Sciences, Department of Biomedical Engineering, and Department of Radiology, College of Medicine, University of North Carolina, Chapel Hill, NC 27599
| | - Connor Puett
- Department of Physics and Astronomy, College of Arts and Sciences, Department of Biomedical Engineering, and Department of Radiology, College of Medicine, University of North Carolina, Chapel Hill, NC 27599
| | - Yueh Z Lee
- Department of Physics and Astronomy, College of Arts and Sciences, Department of Biomedical Engineering, and Department of Radiology, College of Medicine, University of North Carolina, Chapel Hill, NC 27599
| | - Jianping Lu
- Department of Physics and Astronomy, College of Arts and Sciences, Department of Biomedical Engineering, and Department of Radiology, College of Medicine, University of North Carolina, Chapel Hill, NC 27599
| | - Otto Z Zhou
- Department of Physics and Astronomy, College of Arts and Sciences, Department of Biomedical Engineering, and Department of Radiology, College of Medicine, University of North Carolina, Chapel Hill, NC 27599
| | - Kurt T Selberg
- From the Equine Orthopaedic Research Center and Translational Medicine Institute, Department of Clinical Sciences, and Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
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Park S, Lee IS, Song YS, Bae JH, Kim JI, Kim CW. Diagnostic performance of tomosynthesis for evaluation of bone tumors and tumor-like lesions: a comparison with radiography. Acta Radiol 2021; 63:1086-1092. [PMID: 34260321 DOI: 10.1177/02841851211032436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Even though radiologic diagnosis of bone tumors and tumor-like lesions is usually based on radiographs, radiographically faint imaging features sometimes remain challenging due to overlapping anatomical structures. PURPOSE To compare tomosynthesis with radiography for the evaluation of bone tumors and tumor-like lesions. MATERIAL AND METHODS Forty-seven bone tumors and tumor-like lesions were assessed with radiographs and tomosynthesis images. Two radiologists independently analyzed imaging features of lesions, including margin, periosteal reaction, cortical thinning, matrix mineralization, cortical destruction (such as pathologic fracture), and extraosseous soft-tissue extension. Computed tomography (CT) imaging was used as a reference method. Diagnostic performances of radiography and tomosynthesis were analyzed and compared based on sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Effective radiation dose was compared among the three imaging modalities by phantom studies. RESULTS Inter-observer variability (kappa value) for imaging features was slight to moderate on radiography (0.167-0.588), whereas it was nearly perfect on tomosynthesis (0.898-1.000) except for extraosseous soft-tissue extension (0.647 vs. 0.647). Tomosynthesis showed significantly higher sensitivity than radiography in evaluating the margin for bone tumors or tumor-like lesions (1.00 vs. 0.85; P = 0.016), and significantly higher accuracy than radiography in evaluating the margin and matrix mineralization for those (1.00 vs. 0.85; P = 0.016 and 0.91 vs.0.77; P = 0.023, respectively). In phantom studies, mean effective radiation doses were highest in order of CT, tomography, and radiography. CONCLUSION Tomosynthesis increases sensitivity and accuracy of the margin as well as accuracy of the matrix mineralization of bone tumors and tumor-like lesions compared to radiography.
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Affiliation(s)
- Sekyoung Park
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University Hospital, Biomedical Research Institute, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Pusan National University Hospital, Biomedical Research Institute, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - Ji Hyun Bae
- Department of Radiology, Pusan National University Hospital, Pusan National University Hospital, Biomedical Research Institute, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jeong Il Kim
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University Hospital, Biomedical Research Institute, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
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Abstract
The hand and wrist are commonly involved in rheumatic conditions, particularly rheumatoid arthritis and other systemic connective tissue diseases. With spondyloarthritis, hand and wrist involvement frequently occurs in psoriatic arthritis but generally does not occur in the remaining subtypes. The hand and wrist may also be affected in various metabolic and endocrine diseases, but these lie beyond the scope of this review.Radiographs may demonstrate the presence of joint space narrowing, bone loss, cysts and erosions, malalignments, and osteolysis. They may also show regions of soft tissue swelling or thinning, and detect calcifications. Ultrasonography and magnetic resonance imaging (MRI) enable evaluation of the soft tissues, particularly the synovium, tenosynovium, and tendons. Furthermore, erosions are better demonstrated than on radiographs. MRI allows evaluation of periarticular bone marrow edema.This article discusses typical imaging features of the hand and wrist in rheumatologic conditions including the advantages and limitations of the various methods.
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Inscoe CR, Lee Y, Billingsley AJ, Puett C, Nissman D, Lu J, Zhou O. Point-of-Care Tomosynthesis Imaging of the Wrist. Mil Med 2021; 186:745-750. [PMID: 33499472 DOI: 10.1093/milmed/usaa337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Musculoskeletal injury to extremities is a common issue for both stateside and deployed military personnel, as well as the general public. Superposition of anatomy can make diagnosis difficult using standard clinical techniques. There is a need for increased diagnostic accuracy at the point-of-care for military personnel in both training and operational environments, as well as assessment during follow-up treatment to optimize care and expedite return to service. Orthopedic tomosynthesis is rapidly emerging as an alternative to digital radiography (DR), exhibiting an increase in sensitivity for some clinical tasks, including diagnosis and follow-up of fracture and arthritis. Commercially available digital tomosynthesis systems are large complex devices. A compact device for extremity tomosynthesis (TomoE) was previously demonstrated using carbon nanotube X-ray source array technology. The purpose of this study was to prepare and evaluate the prototype device for an Institutional Review Board-approved patient wrist imaging study and provide initial patient imaging results. MATERIALS AND METHODS A benchtop device was constructed using a carbon nanotube X-ray source array and a flat panel digital detector. Twenty-one X-ray projection images of cadaveric specimens and human subjects were acquired at incident angles from -20 to +20 degrees in various clinical orientations, with entrance dose calibrated to commercial digital tomosynthesis wrist scans. The projection images were processed with an iterative reconstruction algorithm in 1 mm slices. Reconstruction slice images were evaluated by a radiologist for feature conspicuity and diagnostic accuracy. RESULTS The TomoE image quality was found to provide more diagnostic information than DR, with reconstruction slices exhibiting delineation of joint space, visual conspicuity of trabecular bone, bone erosions, fractures, and clear depiction of normal anatomical features. The scan time was 15 seconds and the skin entrance dose was verified to be 0.2 mGy. CONCLUSIONS The TomoE device image quality has been evaluated using cadaveric specimens. Dose was calibrated for a patient imaging study. Initial patient images depict a high level of anatomical detail and an increase in diagnostic value compared to DR.
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Affiliation(s)
- Christina R Inscoe
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yueh Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Alex J Billingsley
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27607, USA
| | - Connor Puett
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27607, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jianping Lu
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Otto Zhou
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Cajamarca-Baron J, Calvo Páramo E, Morales Manrique J, Vanegas Jiménez L, Sarmiento-Monroy J, Rojas-Villarraga A. The use of digital tomosynthesis in rheumatology: A systematic review of the literature focused on four diseases. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cajamarca-Baron J, Calvo Páramo E, Manrique JLM, Jiménez LVV, Sarmiento-Monroy JC, Rojas-Villarraga A. The use of digital tomosynthesis in rheumatology: a systematic review of the literature focused on four diseases. RADIOLOGIA 2021; 63:127-144. [PMID: 33451719 DOI: 10.1016/j.rx.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Digital tomosynthesis has proven useful in the evaluation of damage to joints. This study aims to describe the most common digital tomosynthesis findings for four rheumatological entities and to compare the usefulness of this technique with that of other imaging techniques. MATERIALS AND METHODS Following the PRISMA guidelines, we systematically searched the literature for articles about the use of digital tomosynthesis in rheumatoid arthritis, osteoarthritis, spondyloarthritis, and gout. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to evaluate the quality of the articles included. RESULTS We included 13 articles. For rheumatoid arthritis, osteoarthritis, and spondyloarthritis, digital tomosynthesis detected bone abnormalities better than plain-film X-rays; however, for gout, the results were variable. CONCLUSIONS Digital tomosynthesis can play an important role in the evaluation of skeletal abnormalities in rheumatological disease, especially compared to plain-film X-rays.
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Affiliation(s)
- J Cajamarca-Baron
- Médico internista, residente de Reumatología, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia.
| | - E Calvo Páramo
- Radiólogo, profesor titular, Universidad Nacional de Colombia, Hospital Universitario Nacional, Bogotá, Colombia
| | | | | | | | - A Rojas-Villarraga
- Reumatóloga, profesor titular investigador, Instituto de Investigaciones, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
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Martini K, Blüthgen C, Walter JE, Messerli M, Nguyen-Kim TDL, Frauenfelder T. Accuracy of Conventional and Machine Learning Enhanced Chest Radiography for the Assessment of COVID-19 Pneumonia: Intra-Individual Comparison with CT. J Clin Med 2020; 9:jcm9113576. [PMID: 33171999 PMCID: PMC7694629 DOI: 10.3390/jcm9113576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate diagnostic accuracy of conventional radiography (CXR) and machine learning enhanced CXR (mlCXR) for the detection and quantification of disease-extent in COVID-19 patients compared to chest-CT. METHODS Real-time polymerase chain reaction (rt-PCR)-confirmed COVID-19-patients undergoing CXR from March to April 2020 together with COVID-19 negative patients as control group were retrospectively included. Two independent readers assessed CXR and mlCXR images for presence, disease extent and type (consolidation vs. ground-glass opacities (GGOs) of COVID-19-pneumonia. Further, readers had to assign confidence levels to their diagnosis. CT obtained ≤ 36 h from acquisition of CXR served as standard of reference. Inter-reader agreement, sensitivity for detection and disease extent of COVID-19-pneumonia compared to CT was calculated. McNemar test was used to test for significant differences. RESULTS Sixty patients (21 females; median age 61 years, range 38-81 years) were included. Inter-reader agreement improved from good to excellent when mlCXR instead of CXR was used (k = 0.831 vs. k = 0.742). Sensitivity for pneumonia detection improved from 79.5% to 92.3%, however, on the cost of specificity 100% vs. 71.4% (p = 0.031). Overall, sensitivity for the detection of consolidation was higher than for GGO (37.5% vs. 70.4%; respectively). No differences could be found in disease extent estimation between mlCXR and CXR, even though the detection of GGO could be improved. Diagnostic confidence was better on mlCXR compared to CXR (p = 0.013). CONCLUSION In line with the current literature, the sensitivity for detection and quantification of COVID-19-pneumonia was moderate with CXR and could be improved when mlCXR was used for image interpretation.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (J.E.W.); (T.D.L.N.-K.); (T.F.)
- Correspondence: ; Tel.: +41-43-253-11-11
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (J.E.W.); (T.D.L.N.-K.); (T.F.)
| | - Joan E. Walter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (J.E.W.); (T.D.L.N.-K.); (T.F.)
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Thi Dan Linh Nguyen-Kim
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (J.E.W.); (T.D.L.N.-K.); (T.F.)
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (J.E.W.); (T.D.L.N.-K.); (T.F.)
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Abstract
Lung emphysema represents a major public health burden and still accounts for five percent of all deaths worldwide. Hence, it is essential to further understand this disease in order to develop effective diagnostic and therapeutic strategies. Lung emphysema is an irreversible enlargement of the airways distal to the terminal bronchi (i.e., the alveoli) due to the destruction of the alveolar walls. The two most important causes of emphysema are (I) smoking and (II) α1-antitrypsin-deficiency. In the former lung emphysema is predominant in the upper lung parts, the latter is characterized by a predominance in the basal areas of the lungs. Since quantification and evaluation of the distribution of lung emphysema is crucial in treatment planning, imaging plays a central role. Imaging modalities in lung emphysema are manifold: computed tomography (CT) imaging is nowadays the gold standard. However, emerging imaging techniques like dynamic or functional magnetic resonance imaging (MRI), scintigraphy and lately also the implementation of radiomics and artificial intelligence are more and more diffused in the evaluation, diagnosis and quantification of lung emphysema. The aim of this review is to shortly present the different subtypes of lung emphysema, to give an overview on prediction and risk assessment in emphysematous disease and to discuss not only the traditional, but also the new imaging techniques for diagnosis, quantification and evaluation of lung emphysema.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Tang H, Huang X, Cheng X, Yang D, Huang Y, Zhou Y. Evaluation of peri-prosthetic radiolucent lines surrounding the cementless femoral stem using digital tomosynthesis with metal artifact reduction: a cadaveric study in comparison with radiography and computed tomography. Quant Imaging Med Surg 2020; 10:1786-1800. [PMID: 32879857 DOI: 10.21037/qims-19-1018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The traditional criterion for the diagnosis of implant loosening in total hip arthroplasty (THA) was once defined as a radiolucent line of >2 mm in width, based on plain radiography. Recent progress in imaging technology has allowed for the identification of complete radiolucent lines of ≤2 mm around the whole prosthesis as the basis for diagnosing component loosening in the absence of component migration. This study aimed to compare the sensitivity and specificity of digital tomosynthesis with metal artifact reduction with those of radiography and conventional computed tomography (CT) for detecting radiolucent lines of ≤2 mm surrounding cementless femoral stems of different widths. Methods The medullary canals of 4 cadaveric femurs were broached to 13 mm in diameter. Cylindrical cementless femoral stems with diameters of 9, 10, 11, 12, and 13 mm were sequentially inserted into each femur, creating 5 groups of radiolucent lines 2.0, 1.5-1.6, 1.1-1.2, 0.5-0.6, and 0 mm in diameter, respectively. Imaging by tomosynthesis, radiography, and CT was conducted for each radiolucent line model. The width information of the radiolucent line models was used as a reference standard for calculating sensitivity and specificity: observations in the group of 0 mm were used for calculating specificity, and those in the other four groups were used for sensitivity. The differences in sensitivity and specificity between the imaging methods were compared with chi-square test, and the 95% confidence intervals of improvements in the sensitivity and specificity of tomosynthesis compared with radiography and CT were calculated using mixed effects models. Results The overall sensitivity of tomosynthesis (63.3%) for detecting radiolucent lines ≤2 mm wide was significantly higher (P<0.017) than that of radiography (20.5%) and CT (50.2%), an improvement of 58.2%±3.1% (95% CI, P<0.001) and 21.7%±7.1% (95% CI, P<0.001) compared to radiography and CT, respectively. The sensitivity values for detecting radiolucent lines in all four groups by tomosynthesis and CT were significantly higher than those of radiography (P<0.017). Tomosynthesis also had significantly higher sensitivity than CT (P<0.017) in detecting radiolucent line ≤1.2 mm wide. The specificity of TMAR, radiography, and CT for detecting radiolucent lines was 87.5%, 92.5%, and 82.5%, respectively, with no significant difference (P>0.017). Conclusions Digital tomosynthesis with metal artifact reduction had significantly higher sensitivity than radiography for detecting radiolucent lines ≤2 mm wide surrounding cementless femoral stems. It also displayed higher sensitivity than CT for detecting radiolucent lines ≤1.2 mm in width. With a higher rate of detection for radiolucent lines narrower than 2 mm, tomosynthesis has the potential to improve the accuracy of early diagnosis of cementless THA stem loosening in clinical practice.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xingjian Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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Toyooka S, Masuda H, Nishihara N, Shimazaki N, Ando S, Kawano H, Nakagawa T. Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2020; 2:e105-e112. [PMID: 32368746 PMCID: PMC7190547 DOI: 10.1016/j.asmr.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare tomosynthesis and computed tomography (CT) for evaluating bone plug integration after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BPTB) graft. Methods Data of consecutive adult patients who underwent ACL reconstruction with BPTB were analyzed. Bone integration between the bone plug and bone tunnel was evaluated by tomosynthesis and CT, which were both performed 3 months postoperatively. The obtained data for both modalities were reconstructed with slice thickness of 2 mm. Evaluation of bone integration were separately performed using coronal- and sagittal-reconstructed images for the femur and tibia. The ratio of bone integration between the reconstructed slices in which bone grafting was involved, for both tomosynthesis and CT, was investigated by 2 blinded examiners. The equivalence of tomosynthesis to CT was tested by comparing the bone integration ratio for both modalities. The accuracy of diagnosing bone union using tomosynthesis and CT was also investigated. Results The diagnostic accuracy of tomosynthesis and CT exceeded 80%. Interobserver agreement of bone integration in the sagittal plane on the femoral side was 0.92 (intraclass correlation coefficient) for CT and 0.76 (intraclass correlation coefficient) for tomosynthesis. Conclusions Although it showed poor reliability, tomosynthesis was equivalent to CT in evaluating bone plug integration after ACL reconstruction with BPTB. Level of Evidence Level II, diagnostic study.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hironari Masuda
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiro Nishihara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information and Computer Technology Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition. J Clin Med 2019; 8:jcm8122174. [PMID: 31835340 PMCID: PMC6947149 DOI: 10.3390/jcm8122174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.
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Fukui R, Shiraishi J. Application of a pixel-shifted linear interpolation technique for reducing the projection number in tomosynthesis imaging. Radiol Phys Technol 2018; 12:30-39. [PMID: 30456708 DOI: 10.1007/s12194-018-0488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Tomosynthesis images are reconstructed from several projections. However, the number of projections is proportional to the exposure dose, and a reduction in the number of projections would result in a reduction of radiation dose to the patient but also degradation of image quality. The purpose of this study was to propose a new computerized method to supply interpolation images instead of real projection images for maintaining the number of projection images and image quality of reconstructed tomosynthesis images. A set of images comprising one-half the number of projection images [37 projections (Half set)], selected from the original full set of projection images [73 projections (Full set)], was used at an interval of one by one. In this study, the authors used a new linear interpolation technique (Shift-Linear method), which takes into account shifted distances between two corresponding pixels on two projection images. The image quality of tomosynthesis images reconstructed from the full set and the quasi-full projection images, which were produced from the Half set using the Shift-Linear method, was compared. Image quality was assessed in terms of modulation transfer function, noise power spectrum, contrast-to-noise ratio, and the detective quantum efficiency. Using this proposed method, the image quality of reconstructed tomosynthesis images could be maintained with the reduction of approximately 50% exposure dose.
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Affiliation(s)
- Ryohei Fukui
- Graduate School of Health Sciences, Kumamoto University, 4-24-1 Kuhonji, Cyuo-ku, Kumamoto-shi, Kumamoto, 860-0976, Japan. .,Division of Clinical Radiology, Tottori University Hospital, 36-1 Nishimachi, Yonago-shi, Tottori, 683-8504, Japan.
| | - Junji Shiraishi
- Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Cyuo-ku, Kumamoto-shi, Kumamoto, 860-0976, Japan
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Kuramoto T, Morishita J, Kato T, Nakamura Y. Variations in slice sensitivity profile for various height settings in tomosynthesis imaging: Phantom study. Phys Med 2018; 53:108-117. [PMID: 30241745 DOI: 10.1016/j.ejmp.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/14/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022] Open
Abstract
Understanding the properties of slice sensitivity profile (SSP), or slice thickness, is crucial for an accurate and highly reproducible diagnosis using tomosynthesis imaging. The objectives of the present study are therefore to quantitatively evaluate how the SSP with the use of a small metal bead is affected by different settings of the height from the table and the height of the center of rotation (COR) in tomosynthesis imaging except for the digital breast tomosynthesis, and visually verify the effects on tomosynthesis images. The reconstruction filters used were three types of filtered back-projection and iterative reconstructions. The SSP was measured from the full width at half maximum (FWHM-SSP) of the profile curve of the bead in the perpendicular direction (z direction) relative to the table. Two types of anthropomorphic phantoms simulating the human body, with bones and soft tissues, were used to study the effects of different settings for the COR height. In all reconstruction filters, the FWHM-SSP changed as the height of the bead varied when the bead and COR were set to the same height from the table. If the bead and the COR were set to different heights, the FWHM-SSP increased (decreased) when the height of the bead was set to be greater (less) than the height of the COR. These changes were also confirmed on the anthropomorphic phantom images of the bones and soft tissues.
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Affiliation(s)
- Taku Kuramoto
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Junji Morishita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuhiko Nakamura
- Department of Radiological Science, Faculty of Health Sciences, Junshin Gakuen University, 1-1-1, Chikushigaoka, Minami-ku, Fukuoka 815-8510, Japan
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Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening. Eur Radiol 2018; 29:1258-1266. [DOI: 10.1007/s00330-018-5717-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
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Blum A, Noël A, Regent D, Villani N, Gillet R, Gondim Teixeira P. Tomosynthesis in musculoskeletal pathology. Diagn Interv Imaging 2018; 99:423-441. [DOI: 10.1016/j.diii.2018.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023]
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Guo S, Tang H, Zhou Y, Huang Y, Shao H, Yang D. Accuracy of Digital Tomosynthesis With Metal Artifact Reduction for Detecting Osteointegration in Cementless Hip Arthroplasty. J Arthroplasty 2018; 33:1579-1587. [PMID: 29366729 DOI: 10.1016/j.arth.2017.12.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/03/2017] [Accepted: 12/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless hip arthroplasty is increasingly gaining popularity worldwide. Radiologic identification of osteointegration is key to confirming biologic fixation. We conducted the study reported here to determine the sensitivity and specificity of digital tomosynthesis with metal artifact reduction (TMAR), radiography, and conventional computed tomography in detecting osteointegration in cementless hip arthroplasty. METHODS We prospectively included data for 24 patients who underwent revision hip arthroplasty in our hospital, with 13 femoral and 14 acetabular cementless components retrieved that contained solid evidence of biologic fixation. All patients underwent 3 examinations before surgery, and evidence of osteointegration on retrieved prostheses was used as the reference standard. Seven orthopedic surgeons evaluated these images independently using uniform criteria. RESULTS On the femoral side, the sensitivity and specificity of detecting osteointegration were 73.8% ± 4.6% and 94.3% ± 1.5%, respectively, for TMAR; 50.4% ± 5.3% and 87.8% ± 2.1%, respectively, for radiography; and 36.4% ± 5.1% and 90.9% ± 1.9%, respectively, for CT. On the cup side, the corresponding values were 60.2% ± 8.3% and 86.4% ± 5.7%, respectively, for TMAR; 45.9% ± 8.5% and 66.4% ± 7.8%, respectively, for radiography; and 45.1% ± 8.5% and 73.5% ± 7.3%, respectively, by computed tomography. CONCLUSION TMAR significantly improved the accuracy osteointegration detection in cementless hip arthroplasty (P < .017).
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Affiliation(s)
- Shengjie Guo
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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Choi S, Lee H, Lee D, Choi S, Lee CL, Kwon W, Shin J, Seo CW, Kim HJ. Development of a chest digital tomosynthesis R/F system and implementation of low-dose GPU-accelerated compressed sensing (CS) image reconstruction. Med Phys 2018; 45:1871-1888. [PMID: 29500855 DOI: 10.1002/mp.12843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/17/2017] [Accepted: 02/14/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE This work describes the hardware and software developments of a prototype chest digital tomosynthesis (CDT) R/F system. The purpose of this study was to validate the developed system for its possible clinical application on low-dose chest tomosynthesis imaging. METHODS The prototype CDT R/F system was operated by carefully controlling the electromechanical subsystems through a synchronized interface. Once a command signal was delivered by the user, a tomosynthesis sweep started to acquire 81 projection views (PVs) in a limited angular range of ±20°. Among the full projection dataset of 81 images, several sets of 21 (quarter view) and 41 (half view) images with equally spaced angle steps were selected to represent a sparse view condition. GPU-accelerated and total-variation (TV) regularization strategy-based compressed sensing (CS) image reconstruction was implemented. The imaged objects were a flat-field using a copper filter to measure the noise power spectrum (NPS), a Catphan® CTP682 quality assurance (QA) phantom to measure a task-based modulation transfer function (MTFTask ) of three different cylinders' edge, and an anthropomorphic chest phantom with inserted lung nodules. The authors also verified the accelerated computing power over CPU programming by checking the elapsed time required for the CS method. The resultant absorbed and effective doses that were delivered to the chest phantom from two-view digital radiographic projections, helical computed tomography (CT), and the prototype CDT system were compared. RESULTS The prototype CDT system was successfully operated, showing little geometric error with fast rise and fall times of R/F x-ray pulse less than 2 and 10 ms, respectively. The in-plane NPS presented essential symmetric patterns as predicted by the central slice theorem. The NPS images from 21 PVs were provided quite different pattern against 41 and 81 PVs due to aliased noise. The voxel variance values which summed all NPS intensities were inversely proportional to the number of PVs, and the CS method gave much lower voxel variance by the factors of 3.97-6.43 and 2.28-3.36 compared to filtered backprojection (FBP) and 20 iterations of simultaneous algebraic reconstruction technique (SART). The spatial frequencies of the f50 at which the MTFTask reduced to 50% were 1.50, 1.55, and 1.67 cycles/mm for FBP, SART, and CS methods, respectively, in the case of Bone 20% cylinder using 41 views. A variety of ranges of TV reconstruction parameters were implemented during the CS method and we could observe that the NPS and MTFTask preserved best when the regularization and TV smoothing parameters α and τ were in a range of 0.001-0.1. For the chest phantom data, the signal difference to noise ratios (SDNRs) were higher in the proposed CS scheme images than in the FBP and SART, showing the enhanced rate of 1.05-1.43 for half view imaging. The total averaged reconstruction time during 20 iterations of the CS scheme was 124.68 s, which could match-up a clinically feasible time (<3 min). This computing time represented an enhanced speed 386 times greater than CPU programming. The total amounts of estimated effective doses were 0.12, 0.53 (half view), and 2.56 mSv for two-view radiographs, the prototype CDT system, and helical CT, respectively, showing 4.49 times higher than conventional radiography and 4.83 times lower than a CT exam, respectively. CONCLUSIONS The current work describes the development and performance assessment of both hardware and software for tomosynthesis applications. The authors observed reasonable outcomes by showing a potential for low-dose application in CDT imaging using GPU acceleration.
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Affiliation(s)
- Sunghoon Choi
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Haenghwa Lee
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Donghoon Lee
- Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Seungyeon Choi
- Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Chang-Lae Lee
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, 26426, Korea
| | - Jungwook Shin
- LISTEM Corporation, 94 Donghwagongdan-ro, Munmak-eup, Wonju, Korea
| | - Chang-Woo Seo
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Hee-Joung Kim
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea.,Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
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22
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De Silvestro A, Martini K, Becker A, Kim-Nguyen T, Guggenberger R, Calcagni M, Frauenfelder T. Postoperative imaging of orthopaedic hardware in the hand and wrist: is there an added value for tomosynthesis? Clin Radiol 2018; 73:214.e1-214.e9. [DOI: 10.1016/j.crad.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 01/08/2023]
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Teh J, Østergaard M. What the Rheumatologist Is Looking for and What the Radiologist Should Know in Imaging for Rheumatoid Arthritis. Radiol Clin North Am 2017; 55:905-916. [PMID: 28774454 DOI: 10.1016/j.rcl.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article outlines what the rheumatologist is looking for and wants to know in the clinical diagnosis and imaging of rheumatoid arthritis, and what the radiologist should know to facilitate this.
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Affiliation(s)
- James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford OX3 7LD, UK.
| | - Mikkel Østergaard
- Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Kettegaard alle 30, Hvidovre 2650, Denmark
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Son CN, Song Y, Kim SH, Lee S, Jun JB. Digital tomosynthesis as a new diagnostic tool for assessing of chronic gout arthritic feet and ankles: comparison of plain radiography and computed tomography. Clin Rheumatol 2017; 36:2095-2100. [PMID: 28597134 DOI: 10.1007/s10067-017-3710-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/19/2017] [Accepted: 05/26/2017] [Indexed: 12/27/2022]
Abstract
This aimed to compare the three radiographic methods of digital tomosynthesis (DT), plain radiography, and computed tomography (CT) for evaluating changes in feet of patients with chronic gouty arthritis. Two independent radiologists read the plain radiography, DT, and CT images of 30 male patients with gout. The degrees of erosion and joint space narrowing were scored using the Sharp-van der Heijde scoring method in 18 foot joints, which consisted of four proximal interphalangeal and one interphalangeal joint of the first toe, five metatarsophalangeal, five tarsometatarsal, and three naviculo-cuneiform joints of the foot. DT showed high reproducibility [0.929 for intraobserver intraclass correlation coefficient (ICC) and 0.838 for interobserver ICC]. DT showed similar results to those of CT and superior results to those of plain radiography for evaluating radiographic damage [mean total score, 8.5 ± 14.6 (±standard deviation) for plain radiography, 12.9 ± 12.4 for DT, and 12.6 ± 11.2 for CT]. This study showed that DT is a good method for evaluating radiographic changes in patients with gout. Further research is needed to apply DT to actual clinical settings.
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Affiliation(s)
- Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, School of Medicine and Institute for Medical Science, Keimyung University, Daegu, Republic of Korea
| | - Yoonah Song
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine and Institute for Medical Science, Keimyung University, Daegu, Republic of Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea.
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Koo BS, Song Y, Sung YK, Lee S, Jun JB. Prevalence and distribution of sesamoid bones in the hand determined using digital tomosynthesis. Clin Anat 2017; 30:608-613. [DOI: 10.1002/ca.22881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Bon San Koo
- Department of Internal Medicine; Inje University Seoul Paik Hospital, Inje University College of Medicine; Seoul Republic of Korea
| | - Yoonah Song
- Department of Radiology; Hanyang University Hospital for Rheumatic Diseases; Seoul Republic of Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology; Hanyang University Hospital for Rheumatic Diseases; Seoul Republic of Korea
| | - Seunghun Lee
- Department of Radiology; Hanyang University Hospital for Rheumatic Diseases; Seoul Republic of Korea
| | - Jae-Bum Jun
- Department of Rheumatology; Hanyang University Hospital for Rheumatic Diseases; Seoul Republic of Korea
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Martini K, Baessler M, Baumueller S, Frauenfelder T. Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference. PLoS One 2017; 12:e0174285. [PMID: 28301584 PMCID: PMC5354458 DOI: 10.1371/journal.pone.0174285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/06/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To retrospectively evaluate diagnostic performance of dual-energy subtraction radiography (DESR) for interpretation of chest radiographs compared to conventional radiography (CR) using computed tomography (CT) as standard of reference. MATERIAL AND METHODS A total of 199 patients (75 female, median age 67) were included in this institutional review board (IRB)-approved clinical trial. All patients were scanned in posteroanterior and lateral direction with dual-shot DE-technique. Chest CT was performed within ±72 hours. The system provides three types of images: bone weighted-image, soft tissue weighted-image, herein termed as DESR-images, and a standard image, termed CR-image (marked as CR-image). Images were evaluated by two radiologists for presence of inserted life support lines, pneumothorax, pleural effusion, infectious consolidation, interstitial lung changes, tumor, skeletal alterations, soft tissue alterations, aortic or tracheal calcification and pleural thickening. Inter-observer agreement between readers and diagnostic performance were calculated. McNemar's test was used to test for significant differences. RESULTS Mean inter-observer agreement throughout the investigated parameters was higher in DESR images compared to CR-images (kDESR = 0.935 vs. kCR = 0.858). DESR images provided significantly increased sensitivity compared to CR-images for the detection of infectious consolidations (42% vs. 62%), tumor (46% vs. 57%), interstitial lung changes (69% vs. 87%) and aortic or tracheal calcification (25 vs. 73%) (p<0.05). There were no significant differences in sensitivity for the detection of inserted life support lines, pneumothorax, pleural effusion, skeletal alterations, soft tissue alterations or pleural thickening (p>0.05). CONCLUSION DESR increases significantly the sensibility without affecting the specificity evaluating chest radiographs, with emphasis on the detection of interstitial lung diseases.
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Affiliation(s)
- Katharina Martini
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | - Stephan Baumueller
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Ichikawa S, Kamishima T, Sutherland K, Kasahara H, Shimizu Y, Fujimori M, Yasojima N, Ono Y, Kaneda T, Koike T. Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis. J Digit Imaging 2017; 30:369-375. [PMID: 28105533 DOI: 10.1007/s10278-017-9949-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with rheumatoid arthritis (RA), by using the semi-quantitative scoring method as the reference standard. Twenty patients (14 females and 6 males) with RA were included in this retrospective study. All patients underwent radiography and tomosynthesis of the bilateral hand and wrist. Two rheumatologists and a radiologist independently scored JSN with two modalities according to the Sharp/van der Heijde score. Two observers independently measured joint space width on tomosynthesis images using an in-house semi-automated method. More joints with JSN were revealed with tomosynthesis score (243 joints) and the semi-automated method (215 joints) than with radiography (120 joints), and the associations between tomosynthesis scores and radiography scores were demonstrated (P < 0.001). There was significant, negative correlation between measured joint space width and tomosynthesis scores with r = -0.606 (P < 0.001) in metacarpophalangeal joints and r = -0.518 (P < 0.001) in proximal interphalangeal joints. Inter-observer and intra-observer agreement of the semi-automated method using tomosynthesis images was in almost perfect agreement with intra-class correlation coefficient (ICC) values of 0.964 and 0.963, respectively. The semi-automated method using tomosynthesis images provided sensitive, quantitative, and reproducible measurement of finger joint space in patients with RA.
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Affiliation(s)
- Shota Ichikawa
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan.
| | - Kenneth Sutherland
- Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hideki Kasahara
- Department of Rheumatology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Yuka Shimizu
- Division of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Motoshi Fujimori
- Department of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Nobutoshi Yasojima
- Department of Radiology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Yohei Ono
- Department of Radiology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Takahiko Kaneda
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Takao Koike
- Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
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Fukuda T, Umezawa Y, Tojo S, Yonenaga T, Asahina A, Nakagawa H, Fukuda K. Initial Experience of Using Dual-Energy CT with an Iodine Overlay Image for Hand Psoriatic Arthritis: Comparison Study with Contrast-enhanced MR Imaging. Radiology 2017; 284:134-142. [PMID: 28045646 DOI: 10.1148/radiol.2016161671] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To determine the feasibility of dual-energy (DE) computed tomography (CT) with an iodine overlay image (IOI) for evaluation of psoriatic arthritis in the hand. Materials and Methods Approval from the institutional ethics committee and written informed consent from all patients were obtained. This prospective study included 16 patients who had psoriasis with finger joint symptoms from January 2015 to January 2016. Contrast material-enhanced (CE) DE CT and 1.5-T CE magnetic resonance (MR) imaging were performed within 1 month of each other. DE CT was performed with a tube voltage of 80 kV and 140 kV with use of a 0.4-mm tin filter. Images acquired with both modalities were evaluated by two radiologists independently by using a semiquantitative scoring system. Interreader agreement was calculated for each modality: Weighted κ values were calculated for synovitis, flexor tenosynovitis, and extensor peritendonitis, and κ values were calculated for periarticular inflammation. With consensus scores and CE MR images as the reference, the sensitivity and specificity of IOI DE CT for inflammatory lesions were calculated. Statistical analysis of discordant readings was performed by using the McNemar test. Results Interreader agreement for inflammatory lesions was excellent or good (weighted κ = 0.83 and κ = 0.75 in IOI DE CT; weighted κ = 0.81 and κ = 0.87 in CE MR imaging). The sensitivity and specificity of IOI DE CT were 0.78 and 0.87, respectively. Total agreement was 86.3%; however, there were significantly more lesions detected with IOI DE CT than with CE MR imaging alone (134 vs 20 lesions in 1120 evaluated items; P < .001). Sixty-nine percent of the abnormalities detected with IOI DE CT alone were located in distal interphalangeal joints. Conclusion IOI DE CT is a new imaging modality that may be useful for evaluating psoriatic arthritis in the hand, particularly in the detection of inflammatory lesions in small joints, and may be more useful than CE MR imaging, within the limitation that there is no histopathologic reference. © RSNA, 2017.
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Affiliation(s)
- Takeshi Fukuda
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Yoshinori Umezawa
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Shinjiro Tojo
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Takenori Yonenaga
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Akihiko Asahina
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Hidemi Nakagawa
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Kunihiko Fukuda
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
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Tomosynthesis: A new radiologic technique for rapid diagnosis of scaphoid fractures. Surgeon 2016; 16:131-136. [PMID: 28012704 DOI: 10.1016/j.surge.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022]
Abstract
Scaphoid fractures constitute 71% of all carpal bone fractures.1 Early diagnosis and treatment has significant bearing on fracture union rates and better clinical outcomes. While displaced fractures can be readily seen on plain radiograph, undisplaced fractures can require advanced imaging modalities to confirm that diagnosis. Advanced imaging such as Magnetic Resonance Imaging (MRI), Computerised tomography (CT) and bone scintigraphy are routinely used for the diagnosis of scaphoid fractures but require significant radiation exposure, increased cost and can be difficult to access.2 Tomosynthesis is an emerging imaging modality which uses conventional x-ray systems to produce cross-sectional images. There has yet to be extensive research carried out investigating the diagnostic value of tomosynthesis in scaphoid fractures. The aim of this study is to optimise patient positioning for the diagnosis of scaphoid fractures in a cadaveric model and compare the diagnostic yield of tomography to conventional CT. Using four cadaveric specimens, three limb positions were examined in unfractured and fractured scaphoids to determine the optimal limb positions required for visualisation of the scaphoid. As a result of this study, the optimal position for visualisation of the scaphoid and diagnosis of scaphoid fractures has been determined. The results demonstrate that tomosynthesis is as effective as CT scanning in identifying scaphoid fractures in both sensitivity and specificity. By comparison to CT, tomosynthesis is cheaper, has lower radiation exposure, requires fewer hospital resources and can be performed quickly. Tomosynthesis is a valid diagnostic tool for the diagnosis of scaphoid fractures.
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Joo YB, Kim TH, Park J, Joo KB, Song Y, Lee S. Digital tomosynthesis as a new diagnostic tool for evaluation of spine damage in patients with ankylosing spondylitis. Rheumatol Int 2016; 37:207-212. [DOI: 10.1007/s00296-016-3627-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Fujii M, Aoki T, Okada Y, Mori H, Kinoshita S, Hayashida Y, Hajime M, Tanaka K, Tanaka Y, Korogi Y. Prediction of Femoral Neck Strength in Patients with Diabetes Mellitus with Trabecular Bone Analysis and Tomosynthesis Images. Radiology 2016; 281:933-939. [DOI: 10.1148/radiol.2016151657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE The purpose of this study was to quantitatively and qualitatively determine the impact of radiation dose reduction on the image noise and quality of tomosynthesis studies of the wrist. MATERIALS AND METHODS Imaging of six cadaver wrists was performed with tomosynthesis in anteroposterior position at a tube voltage of 60 kV and tube current of 80 mA and subsequently at 60 or 50 kV with different tube currents of 80, 40, or 32 mA. Dose-area products (DAP) were obtained from the electronically logged protocol. Image noise was measured with an ROI. Two independent and blinded readers evaluated all images. Interreader agreement was measured with a Cohen kappa. Readers assessed overall quality and delineation of soft tissue, cortical bone, and trabecular bone on a 4-point Likert scale. RESULTS The highest DAP (3.892 ± 0.432 Gy · cm2) was recorded for images obtained with 60 kV and 80 mA; the lowest (0.857 ± 0.178 Gy · cm2) was recorded for images obtained with 50 kV and 32 mA. Noise was highest when a combination of 50 kV and 32 mA (389 ± 26.6) was used and lowest when a combination of 60 kV and 80 mA (218 ± 12.3) was used. The amount of noise on images acquired using 60 kV and 80 mA was statistically significantly different from the amount measured on all other images (p < 0.0001). Interreader agreement was excellent (κ = 0.93). Delineation of anatomy and overall quality were scored best on images obtained with 60 kV and 80 mA and worst on images obtained with 50 kV and 32 mA. The difference in delineation and quality on images obtained using 50 kV and 40 mA was not statistically significantly different compared with images obtained using 60 kV and 80 mA. CONCLUSION Significant dose reduction for tomosynthesis of the wrist is possible while image quality and delineation of anatomic structures remain preserved.
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Value of tomosynthesis for lesion evaluation of small joints in osteoarthritic hands using the OARSI score. Osteoarthritis Cartilage 2016; 24:1167-71. [PMID: 26828358 DOI: 10.1016/j.joca.2016.01.982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/14/2016] [Accepted: 01/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of tomosynthesis in depicting osteoarthritic lesions in comparison to conventional radiographs, with use of computed tomography (CT) as standard-of-reference. METHODS Imaging of 12 cadaveric hands was performed with tomosynthesis in dorso-palmar (dp) projection, conventional radiographs (dp) and multi-detector CT. Distal interphalangeal joint (DIP)II, DIPIII, proximal interphalangeal joint (PIP)II, PIPIII, first carpometacarpal (CMC) and scaphotrapezotrapezoidal joint (STT) were graded by two independent readers using the Osteoarthritis Research Society International (OARSI) score. The mean score for each feature was calculated for all modalities. Additional wrists were evaluated for presence of calcium pyrophosphate disease (CPPD). CT served as reference-standard. Inter-reader agreement (ICC) was calculated. RESULTS Comparing tomosynthesis and conventional radiographs to CT, the sensitivity for the presence of osteophytes was 95,7% vs 65,2%; for joint space narrowing 95,8% vs 52,1%; for subchondral sclerosis 61,5% vs 51,3%; for lateral deformity 83.3% vs 83,3%; and for subchondral cysts 45,8% vs 29,2%. Erosions were not present. While tomosynthesis showed no significant difference in OARSI score grading to CT (mean OARSI-score CT: 16.8, SD = 10.6; mean OARSI-score Tomosynthesis: 16.3, SD = 9.6; P = 0.84), conventional radiographs had significant lower mean OARSI scores (mean OARSI-score X-ray: 11.1, SD = 8.3; P = 0.04). Inter-reader agreement for OARSI scoring was excellent (ICC = 0.99). CPPD calcifications present in CT, were also visible with tomosynthesis, but not with conventional radiography. CONCLUSION In conclusion, tomosynthesis depicts more osteoarthritic changes in the small joints of the hand than conventional radiography using the OARSI scoring system and CT as the standard of reference.
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Ceder E, Danielson B, Kovàč P, Fogel H, Svalkvist A, Vikgren J, Båth M. THORACIC SPINE IMAGING: A COMPARISON BETWEEN RADIOGRAPHY AND TOMOSYNTHESIS USING VISUAL GRADING CHARACTERISTICS. RADIATION PROTECTION DOSIMETRY 2016; 169:204-210. [PMID: 26868012 DOI: 10.1093/rpd/ncv559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the present study was to evaluate digital tomosynthesis (DTS) in thoracic spine imaging, comparing the reproduction of anatomical structures with that achieved using digital radiography (DR). In a prospective visual grading study, 23 patients referred in 2014 for elective radiographic examination of the thoracic spine were examined using lateral DR and DTS. The DR image and the DTS section images were read in random order by four radiologists, evaluating the ability of the modalities to present a clear reproduction of nine specific relevant structures of the thoracic vertebrae 3, 6 and 9 (T3, T6 and T9). The data were analysed using visual grading characteristics (VGC) analysis. The VGC analysis revealed a statistically significant difference in favour of DTS for all evaluated structures, except for the anterior vertebral edges and lower end plate surfaces of T6 and T9 and the cancellous bone of T9. The difference was most striking in T3 and for posterior structures. For no structure in any vertebra was the reproduction rated significantly better for DR. In conclusion, DTS of the thoracic spine appears to be a promising alternative to DR, especially in areas where the problem of overlaying anatomy is accentuated, such as posterior and upper thoracic structures.
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Affiliation(s)
- Erik Ceder
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Barbro Danielson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Peter Kovàč
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Hanna Fogel
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Angelica Svalkvist
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Båth M, Söderman C, Svalkvist A. RETROSPECTIVE ESTIMATION OF PATIENT DOSE-AREA PRODUCT IN THORACIC SPINE TOMOSYNTHESIS PERFORMED USING VOLUMERAD. RADIATION PROTECTION DOSIMETRY 2016; 169:281-285. [PMID: 26590395 DOI: 10.1093/rpd/ncv475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the use of a recently developed method of retrospectively estimating the patient dose-area product (DAP) of a chest tomosynthesis examination, performed using VolumeRAD, in thoracic spine tomosynthesis and to determine the necessary field-size correction factor. Digital imaging and communications in medicine (DICOM) data for the projection radiographs acquired during a thoracic spine tomosynthesis examination were retrieved directly from the modality for 17 patients. Using the previously developed method, an estimated DAP for the tomosynthesis examination was determined from DICOM data in the scout image. By comparing the estimated DAP with the actual DAP registered for the projection radiographs, a field-size correction factor was determined. The field-size correction factor for thoracic spine tomosynthesis was determined to 0.92. Applying this factor to the DAP estimated retrospectively, the maximum difference between the estimated DAP and the actual DAP was <3 %. In conclusion, the previously developed method of retrospectively estimating the DAP in chest tomosynthesis can be applied to thoracic spine tomosynthesis.
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Affiliation(s)
- Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Christina Söderman
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Angelica Svalkvist
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly. Eur Radiol 2016; 27:491-497. [PMID: 27246721 DOI: 10.1007/s00330-016-4392-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/26/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
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Ono Y, Kashihara R, Yasojima N, Kasahara H, Shimizu Y, Tamura K, Tsutsumi K, Sutherland K, Koike T, Kamishima T. Tomosynthesis can facilitate accurate measurement of joint space width under the condition of the oblique incidence of X-rays in patients with rheumatoid arthritis. Br J Radiol 2016; 89:20150967. [PMID: 27043764 DOI: 10.1259/bjr.20150967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Accurate evaluation of joint space width (JSW) is important in the assessment of rheumatoid arthritis (RA). In clinical radiography of bilateral hands, the oblique incidence of X-rays is unavoidable, which may cause perceptional or measurement error of JSW. The objective of this study was to examine whether tomosynthesis, a recently developed modality, can facilitate a more accurate evaluation of JSW than radiography under the condition of oblique incidence of X-rays. METHODS We investigated quantitative errors derived from the oblique incidence of X-rays by imaging phantoms simulating various finger joint spaces using radiographs and tomosynthesis images. We then compared the qualitative results of the modified total Sharp score of a total of 320 joints from 20 patients with RA between these modalities. RESULTS A quantitative error was prominent when the location of the phantom was shifted along the JSW direction. Modified total Sharp scores of tomosynthesis images were significantly higher than those of radiography, that is to say JSW was regarded as narrower in tomosynthesis than in radiography when finger joints were located where the oblique incidence of X-rays is expected in the JSW direction. CONCLUSION Tomosynthesis can facilitate accurate evaluation of JSW in finger joints of patients with RA, even with oblique incidence of X-rays. ADVANCES IN KNOWLEDGE Accurate evaluation of JSW is necessary for the management of patients with RA. Through phantom and clinical studies, we demonstrate that tomosynthesis may achieve more accurate evaluation of JSW.
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Affiliation(s)
- Yohei Ono
- 1 Department of Radiology, NTT Sapporo Medical Center, Sapporo, Japan
| | - Rina Kashihara
- 2 Department of Radiology, Department of Medical Technology, Sunagawa City Medical Center, Sunagawa, Japan
| | | | - Hideki Kasahara
- 4 Department of Rheumatology, NTT Sapporo Medical Center, Sapporo, Japan
| | - Yuka Shimizu
- 5 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Tamura
- 6 Department of Mechanical Engineering, College of Engineering, Nihon University, Koriyama, Japan
| | - Kaori Tsutsumi
- 7 Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Takao Koike
- 4 Department of Rheumatology, NTT Sapporo Medical Center, Sapporo, Japan
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Omori T, Nakamura S, Shiratori K. Localization of the Patency Capsule by Abdominal Tomosynthesis. Digestion 2016; 91:318-25. [PMID: 25998955 DOI: 10.1159/000381471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/03/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS A patency capsule (PC) is used to assess intestinal patency in patients with known or suspected stricture, but PC localization by plain abdominal X-ray (AXR) is difficult in those patients in whom the PC is not detected in the feces. Tomosynthesis is a promising, cost-effective, and low-radiation digital tomographic technique. This prospective study evaluated its use for PC localization in the intestinal tract. METHODS The study subjects were 49 patients in whom the PC was not detected in the feces and was identified intra-abdominally on AXR films. PC localization in the small or large intestines by AXR alone or by tomosynthesis with AXR was compared with abdominal computed tomography (CT), which is the gold standard. RESULTS The PC was judged in the large and small intestines in 22 and 27 patients by AXR alone versus 34 and 15 patients, respectively, by tomosynthesis combined with AXR. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for PC detection by AXR alone were 52.9, 53.3, 56.2, 50.0, and 53.1%, respectively. The same parameters were 100, 100, 100, 100, and 100%, respectively, for tomosynthesis with AXR, which were identical to those of CT. CONCLUSIONS Tomosynthesis with AXR is superior to AXR alone, though similar to CT, with respect to localization of the PC.
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Affiliation(s)
- Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
OBJECTIVE To document the role of digital tomosynthesis (DTS) in the evaluation and treatment of orthopaedic trauma patients. DESIGN Retrospective case series. SETTING Level 1 trauma center with nonunion referral patient population. PARTICIPANTS Four orthopaedic trauma patients with musculoskeletal injuries. INTERVENTION Three revision surgical procedures and 1 conservative treatment for patients with periprosthetic fractures or nonunions. RESULTS DTS successfully visualized 2 nonunions, 1 refracture, and 1 arthrodesis. MAIN OUTCOME MEASURE Documented fracture or nonunion on imaging. CONCLUSIONS DTS has the potential to be of significant value in the detection and follow-up of fractures. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Hayashi D, Xu L, Gusenburg J, Roemer FW, Hunter DJ, Li L, Guermazi A. Reliability of semiquantitative assessment of osteophytes and subchondral cysts on tomosynthesis images by radiologists with different levels of expertise. Diagn Interv Radiol 2015; 20:353-9. [PMID: 24834489 DOI: 10.5152/dir.2014.13283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess reliability of the evaluation of osteophytes and subchondral cysts on tomosynthesis images when read by radiologists with different levels of expertise. MATERIALS AND METHODS Forty subjects aged >40 years had both knees evaluated using tomosynthesis. Images were read by an "experienced" reader (musculoskeletal radiologist with prior experience) and an "inexperienced" reader (radiology resident with no prior experience). Readers graded osteophytes from 0 to 3 and noted the presence/absence of subchondral cysts in four locations of the tibiofemoral joint. Twenty knees were randomly selected and re-read. Inter- and intrareader reliabilities were calculated using overall exact percent agreement and weighted κ statistics. Diagnostic performance of the two readers was compared against magnetic resonance imaging readings by an expert reader (professor of musculoskeletal radiology). RESULTS The experienced reader showed substantial intrareader reliability for graded reading of osteophytes (90%, κ=0.93), osteophyte detection (95%, κ=0.86) and cyst detection (95%, κ=0.83). The inexperienced reader showed perfect intrareader reliability for cyst detection (100%, κ=1.00) but intrareader reliability for graded reading (75%, κ=0.79) and detection (80%, κ=0.61) of osteophytes was lower than the experienced reader. Inter-reader reliability was 61% (κ=0.72) for graded osteophyte reading, 91% (κ=0.82) for osteophyte detection, and 88% (κ=0.66) for cyst detection. Diagnostic performance of the experienced reader was higher than the inexperienced reader regarding osteophyte detection (sensitivity range 0.74-0.95 vs. 0.54-0.75 for all locations) but diagnostic performance was similar for subchondral cysts. CONCLUSION Tomosynthesis offers excellent intrareader reliability regardless of the reader experience, but experience is important for detection of osteophytes.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA.
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Use of Tomosynthesis for Detection of Bone Erosions of the Foot in Patients With Established Rheumatoid Arthritis: Comparison With Radiography and CT. AJR Am J Roentgenol 2015. [PMID: 26204289 DOI: 10.2214/ajr.14.14120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare tomosynthesis with radiography for the detection of bone erosions of the foot in patients with established rheumatoid arthritis (RA) using MDCT as a reference standard. SUBJECTS AND METHODS Eighteen consecutive patients with established RA were included. Each patient underwent radiography, tomosynthesis, and CT examinations of the feet on the same day. Two radiologists independently determined the number of bone erosions and the Sharp-van der Heijde score with each of the three imaging modalities. RESULTS On a total of 216 joints from 18 patients, 216 bone erosions were detected on CT, 215 on tomosynthesis, and 181 with radiography. The mean (± SD) Sharp-van der Heijde score was equivalent for tomosynthesis (18.8 ± 16.8) and CT (19.8 ± 18.5) but was statistically lower for radiography (16.4 ± 18.0) (p = 0.030). The respective overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for tomosynthesis were 80%, 75%, 78%, 76%, and 80%, whereas the respective corresponding values for radiography were 66%, 81%, 74%, 77%, and 71%. The radiation burden of tomosynthesis was almost equivalent to that of radiography. CONCLUSION Tomosynthesis has a higher sensitivity than radiography to detect bone erosions of the foot in patients with established RA and imparts an almost equivalent radiation burden.
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Ono Y, Kamishima T, Yasojima N, Tamura K, Tsutsumi K. Detection and measurement of rheumatoid bone and joint lesions of fingers by tomosynthesis: a phantom study for reconstruction filter setting optimization. Radiol Phys Technol 2015; 9:6-14. [PMID: 26092218 DOI: 10.1007/s12194-015-0327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic disease that is caused by autoimmunity. RA causes synovial proliferation, which may result in bone erosion and joint space narrowing in the affected joint. Tomosynthesis is a promising modality which may detect early bone lesions such as small bone erosion and slight joint space narrowing. Nevertheless, so far, the optimal reconstruction filter for detection of early bone lesions of fingers on tomosynthesis has not yet been known. Our purpose in this study was to determine an optimal reconstruction filter setting by using a bone phantom. We obtained images of a cylindrical phantom with holes simulating bone erosions (diameters of 0.6, 0.8, 1.0, 1.2, and 1.4 mm) and joint spaces by aligning two phantoms (space widths from 0.5 to 5.0 mm with 0.5 mm intervals), examining six reconstruction filters by using tomosynthesis. We carried out an accuracy test of the bone erosion size and joint space width, done by one radiological technologist, and a test to assess the visibility of bone erosion, done by five radiological technologists. No statistically significant difference was observed in the measured bone erosion size and joint space width among all of the reconstruction filters. In the visibility assessment test, reconstruction filters of Thickness+- and Thickness-- were among the best statistically in all characteristics except the signal-to-noise ratio. The Thickness+- and Thickness-- reconstruction filter may be optimal for evaluation of RA bone lesions of small joints in tomosynthesis.
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Affiliation(s)
- Yohei Ono
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan.
| | - Nobutoshi Yasojima
- Department of Radiology, NTT East Japan Sapporo Hospital, South-1, West-15, Cyuo-ku, Sapporo, 060 0061, Japan
| | - Kenichi Tamura
- Department of Mechanical Engineering, College of Engineering, Nihon University, Nakagawara, Tokusada, Tamuramachi, Koriyama, Fukushima Prefecture, 963 8642, Japan
| | - Kaori Tsutsumi
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
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Huang M, Schweitzer ME. The role of radiology in the evolution of the understanding of articular disease. Radiology 2015; 273:S1-22. [PMID: 25340431 DOI: 10.1148/radiol.14140270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Both the clinical practice of radiology and the journal Radiology have had an enormous effect on our understanding of articular disease. Early descriptions of osteoarthritis (OA) appeared in Radiology. More recently, advanced physiologic magnetic resonance (MR) techniques have furthered our understanding of the early prestructural changes in patients with OA. Sodium imaging, delayed gadolinium-enhanced MR imaging of cartilage, and spin-lattice relaxation in the rotating frame (or T1ρ) sequences have advanced understanding of the pathophysiology and pathoanatomy of OA. Many pioneering articles on rheumatoid arthritis (RA) also have been published in Radiology. In the intervening decades, our understanding of the natural history of RA has been altered by these articles. Many of the first descriptions of crystalline arthropathies, including gout, calcium pyrophosphate deposition, and hydroxyapatite deposition disease, appeared in Radiology.
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Affiliation(s)
- Mingqian Huang
- From the Department of Radiology, University of Stony Brook, HSC Level 4, Room 120, Stony Brook, NY 11746
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Tripathi D, Agarwal V. Quantifying synovial inflammation: Emerging imaging techniques. World J Rheumatol 2014; 4:72-79. [DOI: 10.5499/wjr.v4.i3.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/23/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging techniques to assess synovial inflammation includes radiography, ultrasound, computed tomography, magnetic resonance imaging (MRI) and recently positron emission tomography. The ideal objective of imaging approaches are to quantify synovial inflammation by capturing features such as synovial hyperplasia, neo-angiogenesis and infiltration of immune cells in the synovium. This may enable clinicians to estimate response to therapy by measuring the improvement in the inflammatory signals at the level of synovium. Ultrasound can provide information regarding thickening of the synovial membrane and can reveal increased synovial blood flow using power Doppler technique. Bone marrow edema and synovial membrane thickness on MRI scan may serve as indicators for arthritis progression. Enhancement of the synovium on dynamic contrast MRI may closely mirror the inflammatory activity in the synovium. Diffusion tensor imaging is an advance MRI approach that evaluates the inflammation related to cell infiltration or aggregation in an inflamed synovium. In this review, we summarize the newer imaging techniques and their developments to evaluate synovial inflammation.
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MDCT of the hand and wrist: beyond trauma. Emerg Radiol 2014; 22:307-14. [DOI: 10.1007/s10140-014-1274-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/26/2014] [Indexed: 11/27/2022]
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Wawer R, Budzik JF, Demondion X, Forzy G, Cotten A. Carpal pseudoerosions: a plain X-ray interpretation pitfall. Skeletal Radiol 2014; 43:1377-85. [PMID: 24902509 DOI: 10.1007/s00256-014-1907-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/07/2014] [Accepted: 05/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine in detail images of pseudoerosion of the wrist and hand on plain radiographs. MATERIAL AND METHODS The study was conducted with 28 cadaver wrists. During a single imaging session three techniques-plain radiography, tomosynthesis, and computed tomography-were used to visualize the wrist and hand specimens. For each technique, 20 radio-ulno-carpo-metacarpal sites known to present bone erosions in rheumatoid arthritis were analyzed by two radiologists using a standard system to score the cortical bone: normal, pseudoerosion, true erosion, or other pathology. Cohen's concordance analysis was performed to determine inter-observer and intra-observer (for the senior radiologist) agreement by site and by technique. Serial sections of two cadaver specimens were examined to determine the anatomical correlation of the pseudoerosions. RESULTS On the plain radiographs, the radiologists scored many images as pseudoerosion (7.3%), particularly in the distal ulnar portion of the capitate, the distal radial portion of the hamate, the proximal ulnar portion of the base of the third metacarpal, the proximal radial portion of the base of the fourth metacarpal, the distal ulnar portion of the hamate, and the proximal portion of the base of the fifth metacarpal. The computed tomography scan revealed that none of these doubtful images corresponded to true erosions. The anatomical correlation study showed that these images could probably be attributed to ligament insertions, thinner lamina, and enhanced cortical bone transparency. CONCLUSION Knowledge of the anatomical carpal localizations where pseudoerosions commonly occur is a necessary prerequisite for analysis of plain radiographs performed to diagnose or monitor rheumatoid arthritis.
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Affiliation(s)
- Richard Wawer
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Service d'imagerie médicale, Hôpital St Vincent de Paul, Faculté Libre de Médecine, Université Catholique de Lille, boulevard de Belfort, 59000, Lille, France,
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Dalbeth N, Gao A, Roger M, Doyle AJ, McQueen FM. Digital tomosynthesis for bone erosion scoring in gout: comparison with plain radiography and computed tomography. Rheumatology (Oxford) 2014; 53:1712-3. [DOI: 10.1093/rheumatology/keu250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tomosynthesis of the Wrist and Hand in Patients With Rheumatoid Arthritis: Comparison With Radiography and MRI. AJR Am J Roentgenol 2014; 202:386-90. [DOI: 10.2214/ajr.12.10029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fukui R, Ishii R, Kishimoto J, Yamato S, Takahata A, Kohama C. Evaluation of the effect of geometry for measuring section thickness in tomosynthesis. Radiol Phys Technol 2014; 7:141-7. [DOI: 10.1007/s12194-013-0243-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/08/2013] [Accepted: 11/10/2013] [Indexed: 11/24/2022]
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The utility of digital linear tomosynthesis imaging of total hip joint arthroplasty with suspicion of loosening: a prospective study in 40 patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:594631. [PMID: 24078921 PMCID: PMC3776365 DOI: 10.1155/2013/594631] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/24/2022]
Abstract
Aim. The clinical utility of digital linear tomosynthesis in musculoskeletal applications has been validated in only a few reports. Technical performance and utility in hip prosthesis imaging have been discussed in technical reports, but no clinical evaluation has been reported. The purpose of the current study was to assess the added clinical utility of digital linear tomosynthesis compared to radiography in loosening of total hip joint arthroplasty. Materials and Methods. In a prospective study, radiography and digital tomosynthesis were performed in 40 consecutive patients with total hip arthroplasty referred for suspect prosthesis loosening. Tomosynthesis images were compared to anterior-posterior (AP) and cross-table lateral radiographs regarding demarcation and extent of demineralization and osteolysis. Further noted were skeletal fractures, cement fractures, fragmentation, and artifacts interfering with the diagnosis. Results. Tomosynthesis was superior to radiography with sharper delineation of demineralization and osteolysis in the AP projection. A limitation was the inability to generate lateral tomosynthesis images, with inferior assessment of the area anterior and posterior to the acetabular cup compared to cross-table radiographs. Artifacts interfering with diagnosis were found in one hip. Conclusion. Tomosynthesis improved evaluation of total hip arthroplasty in the AP projection but was limited by the lack of lateral projections.
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