Osteoblastic lesion screening with an advanced post-processing package enabling in-plane rib reading in CT-images

Added Value of CT Pelvic Bone Unfolding Software to Radiologist Performance in Detecting Osteoblastic Pelvic Bone Lesions in Patients With Prostate Cancer

PURPOSE

To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer.

METHODS

A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package "CT Bone Unfolding." Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference.

RESULTS

In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method (P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy (P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold (P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936).

CONCLUSIONS

The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

Evaluation of a two-image technique consisting of an axial and a coronal image generated by using the rib-flattening application: effect on reading time and diagnostic validity

Background/aim

When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients.

Materials and methods

The local Institutional Review Board approved this retrospective study. Two radiologists with different experience levels reviewed chest CT examinations of 106 patients (76 men, 30 women). We divided the patients into group A (n = 54), reviewed by a standard method, and group B (n = 52), reviewed by a standard method and the two-image set created on the rib-flattening application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers.

Results

The median reading time of the junior examiner significantly decreased with the rib-flattening method (160.5 s vs. 70.0 s; P < 0.001). Diagnostic indices of the senior reader were improved significantly at per patient level (group A, AUC: 0.867; group B, AUC: 0.982; P = 0.046). The new method showed better agreement levels (kappa: 0.69 to 0.96) than the general method (kappa: 0.53 to 0.91).

Conclusion

Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.

Automatic rib unfolding in postmortem computed tomography: diagnostic evaluation of the OpenRib software compared with the autopsy in the detection of rib fractures

OBJECTIVES

The main objective of this study was to evaluate the diagnostic performance of the OpenRib software against the gold standard of autopsy in the detection of rib fractures. The secondary objective was to measure inter-rater agreement between each radiological reader.

MATERIALS AND METHODS

Thirty-six subjects who underwent postmortem CT and autopsy were included in this study. Rib fractures were first assessed during the autopsy by carefully dissecting and examining each rib. They were also independently evaluated by three readers using OpenRib software. This software produces from postmortem CT images a reformat of the rib cage and a display of all ribs in a single plane. Each reader was asked to determine if the rib was fractured and, if so, whether the fracture was single or multiple.

RESULTS

After exclusions, 649 ribs were included in the statistical analysis. The two readers with a similar level of experience showed a satisfactory inter-rater agreement and a sensitivity of 0.73 and 0.83 with a specificity of 0.95 and 0.91. However, the experienced reader diagnosed significantly more fractures than the autopsy and the other two readers (p < 0.001).

CONCLUSION

The use of automatic rib unfolding software in postmortem CT allows an efficient and accurate assessment of rib fractures and enables the diagnosis of fractures that cannot be detected during a standard autopsy. For now, this method seems to be the simplest that can be routinely performed; however, it requires training time in order to be sufficiently effective.

Automated 3D Rendering of Ribs in 110 Polytrauma Patients: Strengths and Limitations

RATIONALE AND OBJECTIVES

To evaluate the strengths and limitations of a rib-unfolding software in a polytrauma context.

MATERIALS AND METHODS

Chest computed tomography (CT) examinations of 110 patients were reviewed for specific detection of rib fractures using: (1) transverse CT sections ±  multiplanar reformattings (ie, the standard of reference), and (2) unfolded rib images reconstructed by the CT Bone Reading software with the possibility of rib analysis along their long axis and creation of standard orthogonal views in different orientations of any area suspected of fracture.

RESULTS

The software provided complete reconstruction of the whole rib cage in 94 patients (85.5%) and partially incomplete reconstruction in 16 patients (14.5%). The percentage of ribs inadequately reconstructed was 1.5% (40 of 2640 ribs), mainly related to unfused epiphyses (13 of 40), costal hypoplasia (8 of 40), and vertebral fracture (6 of 40). The sensitivity and specificity in detecting rib fractures at a per-patient, per-rib, and per-costal arc level ranged from 0.73 to 0.84 and 0.99 to 1, respectively. At a costal arc level, the reader's misinterpretations accounted for 67% (4 of 6) of false-positive and 24% (20/84) of false-negative results, and interpretive difficulties were encountered for single-cortex fractures or fractures at the extremities of the costal shaft.

CONCLUSIONS

An accurate diagnosis of rib fracture was achieved with the reading of unfolded rib images. In a polytrauma context, the evaluated system could facilitate rib analysis.