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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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Funding

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

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  1. Florian Hagen
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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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