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- Title:
Feasibility of Dark-Field Radiography to Enhance Detection of Nondisplaced Fractures.
- Document type:
- Journal Article
- Author(s):
- Schaff, Florian; Jud, Christoph; Dierolf, Martin; Günther, Benedikt; Achterhold, Klaus; Gleich, Bernhard; Sauter, Andreas; Woertler, Klaus; Thalhammer, Johannes; Meurer, Felix; Neumann, Jan; Pfeiffer, Franz; Pfeiffer, Daniela
- Abstract:
- Background Many clinically relevant fractures are occult on conventional radiographs and therefore challenging to diagnose reliably. X-ray dark-field radiography is a developing method that uses x-ray scattering as an additional signal source. Purpose To investigate whether x-ray dark-field radiography enhances the depiction of radiographically occult fractures in an experimental model compared with attenuation-based radiography alone and whether the directional dependence of dark-field signal impacts observer ratings. Materials and Methods Four porcine loin ribs had nondisplaced fractures experimentally introduced. Microstructural changes were visually verified using high-spatial-resolution three-dimensional micro-CT. X-ray dark-field radiographs were obtained before and after fracture, with the before-fracture scans serving as control images. The presence of a fracture was scored by three observers using a six-point scale (6, surely; 5, very likely; 4, likely; 3, unlikely; 2, very unlikely; and 1, certainly not). Differences between scores based on attenuation radiographs alone (n = 96) and based on combined attenuation and dark-field radiographs (n = 96) were evaluated by using the DeLong method to compare areas under the receiver operating characteristic curve. The impact of the dark-field signal directional sensitivity on observer ratings was evaluated using the Wilcoxon test. The dark-field data were split into four groups (24 images per group) according to their sensitivity orientation and tested against each other. Musculoskeletal dark-field radiography was further demonstrated on human finger and foot specimens. Results The addition of dark-field radiographs was found to increase the area under the receiver operating characteristic curve to 1 compared with an area under the receiver operating characteristic curve of 0.87 (95% CI: 0.80, 0.94) using attenuation-based radiographs alone (P < .001). There were similar observer ratings for the four different dark-field sensitivity orientations (P = .16-.65 between the groups). Conclusion These results suggested that the inclusion of dark-field radiography has the potential to help enhance the detection of nondisplaced fractures compared with attenuation-based radiography alone. © RSNA, 2024 See also the editorial by Rubin in this issue.
- Journal title abbreviation:
- Radiology
- Year:
- 2024
- Journal volume:
- 311
- Journal issue:
- 2
- Fulltext / DOI:
- doi:10.1148/radiol.231921
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/38805732
- Print-ISSN:
- 0033-8419
- TUM Institution:
- Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski)
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