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Effects of different virtual monoenergetic CT image data on chest wall post-processing “unfolded ribs” and proposal of an algorithm improvement

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

To find out if the use of different virtual monoenergetic data sets enabled by DECT technology might have a negative impact on post-processing applications, specifically in case of the “unfolded ribs” algorithm. Metal or beam hardening artifacts are suspected to generate image artifacts and thus reduce diagnostic accuracy. This paper tries to find out how the generation of “unfolded rib” CT image reformates is influenced by different virtual monoenergetic CT images and looks for possible improvement of the post-processing tool.

Material and methods

Between March 2021 and April 2021, thin-slice dual-energy CT image data of the chest were used creating “unfolded rib” reformates. The same data sets were analyzed in three steps: first the gold standard with the original algorithm on mixed image data sets followed by the original algorithm on different keV levels (40–120 keV) and finally using a modified algorithm which in the first step used segmentation based on mixed image data sets, followed by segmentation based on different keV levels. Image quality (presence of artifacts), lesion and fracture detectability were assessed for all series.

Results

Both, the original and the modified algorithm resulted in more artifact-free image data sets compared to the gold standard. The modified algorithm resulted in significantly more artifact-free image data sets at the keV-edges (40–120 keV) compared the original algorithm. Especially “black artifacts” and pseudo-lesions, potentially inducing false positive findings, could be reduced in all keV level with the modified algorithm. Detection of focal sclerotic, lytic or mixed (k = 0.990–1.000) lesions was very good for all keV levels. The Fleiss-kappa test for detection of fresh and old rib fractures was ≥ 0.997.

Conclusion

The use of different virtual monoenergetic keVs for the “unfolded rib” algorithm is generating different artifacts. Segmentation-based artifacts could be eliminated by the proposed new algorithm, showing the best results at 70–80 keV.

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References

  1. Kanatani R, Shirasaka T, Kojima T, Kato T, Kawakubo M (2021) Influence of beam hardening in dual-energy CT imaging: phantom study for iodine mapping, virtual monoenergetic imaging, and virtual non-contrast imaging. Eur Radiol Exp 5:18. https://doi.org/10.1186/s41747-021-00217-1

    Article  Google Scholar 

  2. Gupta A, Obmann VC, Jordan M, Lennartz S, Obmann MM, Große Hokamp N, Zopfs D, Pennig L, Fürtjes G, Ramaiya N, Gilkeson R, Laukamp KRCT (2021) Artifacts after contrast media injection in chest imaging: evaluation of post-processing algorithms, virtual monoenergetic images and their combination for artifact reduction. Quant Imaging Med Surg 11:226–239. https://doi.org/10.21037/qims-20-435

    Article  Google Scholar 

  3. Lennartz S, Große Hokamp N, Zäske C, Zopfs D, Bratke G, Glauner A, Maintz D, Persigehl T, Chang D, Hickethier T (2020) Virtual monoenergetic images preserve diagnostic assessability in contrast media reduced abdominal spectral detector CT. Br J Radiol 93:20200340. https://doi.org/10.1259/bjr.20200340

    Article  Google Scholar 

  4. Blum A, Gillet R, Rauch A, Urbaneja A, Biouichi H, Dodin G, Germain E, Lombard C, Jaquet P, Louis M, Simon L, Gondim TP (2020) 3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future. Diagn Interv Imaging 101:693–705. https://doi.org/10.1016/j.diii.2020.09.008

    Article  CAS  Google Scholar 

  5. Bier G, Mustafa DF, Kloth C, Weisel K, Ditt H, Nikolaou K, Horger M (2016) Improved follow-up and response monitoring of thoracic cage involvement in multiple myeloma using a novel CT postprocessing software: the lessons we learned. AJR Am J Roentgenol 206:57–63. https://doi.org/10.2214/AJR.15.15089

    Article  Google Scholar 

  6. Homann G, Weisel K, Mustafa DF, Ditt H, Nikolaou K, Horger M (2015) Improvement of diagnostic confidence for detection of multiple myeloma involvement of the ribs by a new CT software generating rib unfolded images: comparison with 5- and 1-mm axial images. Skeletal Radiol 44:971–979. https://doi.org/10.1007/s00256-015-2131-7

    Article  Google Scholar 

  7. Ekert K, Kloth C, Fritz J, Ioanoviciu SD, Horger M (2020) Improved detection of benign and malignant rib lesions in the routine computed tomography workup of oncological patients using automated unfolded rib image postprocessing. Invest Radiol 55:84–90. https://doi.org/10.1097/RLI.0000000000000599

    Article  Google Scholar 

  8. Ringl H, Lazar M, Töpker M, Woitek R, Prosch H, Asenbaum U, Balassy C, Toth D, Weber M, Hajdu S, Soza G, Wimmer A, Mang T (2015) The ribs unfolded - a CT visualization algorithm for fast detection of rib fractures: effect on sensitivity and specificity in trauma patients. Eur Radiol 25:1865–1874. https://doi.org/10.1007/s00330-015-3598-2

    Article  Google Scholar 

  9. Kolopp M, Douis N, Urbaneja A, Baumann C, Gondim Teixeira PA, Blum A, Martrille L (2020) Automatic rib unfolding in postmortem computed tomography: diagnostic evaluation of the OpenRib software compared with the autopsy in the detection of rib fractures. Int J Legal Med 134:339–346. https://doi.org/10.1007/s00414-019-02195-x

    Article  Google Scholar 

  10. Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 199:S9–S15. https://doi.org/10.2214/AJR.12.9121

    Article  Google Scholar 

  11. Pregler B, Beyer LP, Da Platz Batista Silva N, Steer S, Zeman F, Popp D, Stroszczynski C, Müller-Wille R. Assessment of Rib Fracture in Acute Trauma Using Automatic Rib Segmentation and a Curved, Unfolded View of the Ribs: Is There a Saving of Time? Journal of clinical medicine 2022;11. doi:https://doi.org/10.3390/jcm11092502.

  12. Bier G, Schabel C, Othman A, Bongers MN, Schmehl J, Ditt H, Nikolaou K, Bamberg F, Notohamiprodjo M (2015) Enhanced reading time efficiency by use of automatically unfolded CT rib reformations in acute trauma. Eur J Radiol 84:2173–2180. https://doi.org/10.1016/j.ejrad.2015.07.023

    Article  Google Scholar 

  13. H Martinke (2017) Advanced bone visualization. Dissertation. Magdeburg, Germany

  14. Laukamp KR, Zopfs D, Wagner A, Lennartz S, Pennig L, Borggrefe J, Ramaiya N, Große HN (2019) CT artifacts from port systems: Virtual monoenergetic reconstructions from spectral-detector CT reduce artifacts and improve depiction of surrounding tissue. Eur J Radiol 121:108733. https://doi.org/10.1016/j.ejrad.2019.108733

    Article  Google Scholar 

  15. Pennig L, Zopfs D, Gertz R, Bremm J, Zaeske C, Große Hokamp N, Celik E, Goertz L, Langenbach M, Persigehl T, Gupta A, Borggrefe J, Lennartz S, Laukamp KR (2021) Reduction of CT artifacts from cardiac implantable electronic devices using a combination of virtual monoenergetic images and post-processing algorithms. Eur Radiol 31:7151–7161. https://doi.org/10.1007/s00330-021-07746-8

    Article  Google Scholar 

  16. Lenga L, Albrecht MH, Othman AE, Martin SS, Leithner D, D’Angelo T, Arendt C, Scholtz JE, De Cecco CN, Schoepf UJ, Vogl TJ, Wichmann JL (2017) Monoenergetic Dual-energy Computed Tomographic Imaging: Cardiothoracic Applications. J Thorac Imaging 32:151–158. https://doi.org/10.1097/RTI.0000000000000259

    Article  Google Scholar 

  17. Hirairi T, Ichikawa K, Urikura A, Sugiyama M, Asegawa S, Matsunami T (2020) Improvement of beam hardening effects of virtual monochromatic image in dual-energy CT: a electron density phantom study. Nihon Hoshasen Gijutsu Gakkai zasshi 76:168–176. https://doi.org/10.6009/jjrt.2020_JSRT_76.2.168

    Article  CAS  Google Scholar 

  18. Kuchenbecker S, Faby S, Sawall S, Lell M, Kachelrieß M (2015) Dual energy CT: how well can pseudo-monochromatic imaging reduce metal artifacts? Med Phys 42:1023–1036. https://doi.org/10.1118/1.4905106

    Article  Google Scholar 

  19. Schmoee J, Dirrichs T, Fehrenbacher K, Tietz E, Hardt F, Schmid M, Gohmann RF, Reinartz SD (2020) Virtual monoenergetic images (VMI+) in dual-source dual-energy CT venography (DSDE-CTV) of the lower extremity prior to coronary artery bypass graft (CABG): a feasibility study. Acad Radiol 27:1249–1254. https://doi.org/10.1016/j.acra.2019.11.005

    Article  Google Scholar 

  20. Laukamp KR, Große Hokamp N, Alabar O, Obmann VC, Lennartz S, Zopfs D, Gilkeson R, Ramaiya N, Gupta A (2020) Metal artifacts from sternal wires: evaluation of virtual monoenergetic images from spectral-detector CT for artifact reduction. Clin Imaging 60:249–256. https://doi.org/10.1016/j.clinimag.2019.12.018

    Article  Google Scholar 

  21. Neuhaus V, Große Hokamp N, Abdullayev N, Rau R, Mpotsaris A, Maintz D, Borggrefe J (2017) Metal artifact reduction by dual-layer computed tomography using virtual monoenergetic images. Eur J Radiol 93:143–148. https://doi.org/10.1016/j.ejrad.2017.05.013

    Article  Google Scholar 

  22. Goo HW, Goo JM (2017) Dual-energy CT: new horizon in medical imaging. Korean J Radiol 18:555–569. https://doi.org/10.3348/kjr.2017.18.4.555

    Article  Google Scholar 

  23. Rassouli N, Etesami M, Dhanantwari A, Rajiah P (2017) Detector-based spectral CT with a novel dual-layer technology: principles and applications. Insights Imaging 8:589–598. https://doi.org/10.1007/s13244-017-0571-4

    Article  Google Scholar 

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No funding was perceived for this study.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany

    Florian Hagen, Lukas Walder, Robin Wrazidlo, Baumgartner Karolin, Johannes Hofmann, Arne Estler & Marius Horger

  2. Siemens Healthcare GmbH, Erlangen, Germany

    Rainer Grimmer & Hendrik Ditt

Authors
  1. Florian Hagen
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  2. Rainer Grimmer
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Correspondence to Florian Hagen.

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Conflict of interests

Florian Hagen has no conflict of interest. Rainer Grimmer is employed by Siemens Healthcare GmbH, Hendrik Ditt is employed by Siemens Healthcare GmbH, Lukas Walder has no conflict of interest, Robin Wrazidlo has no conflict of interest, Baumgartner Karolin has no conflict of interest, Johannes Hofmann has no conflict of interest, Arne Estler has no conflict of interest, Marius Horger has received institutional research support from Siemens Healthineers Germany and GE USA. He is a scientific advisor of Siemens Healthineers Germany and has received speaker's honorarium from Siemens Healthineers Germany and GE USA.

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"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Verbal and written informed consent were waived due to the retrospective nature of the study.”

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Hagen, F., Grimmer, R., Ditt, H. et al. Effects of different virtual monoenergetic CT image data on chest wall post-processing “unfolded ribs” and proposal of an algorithm improvement. Int J CARS 18, 339–351 (2023). https://doi.org/10.1007/s11548-022-02721-0

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  • DOI: https://doi.org/10.1007/s11548-022-02721-0

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