Diagnostic Accuracy for Acute Rib Fractures: A Cross-sectional Study Utilizing Automatic Rib Unfolding and 3D Volume-Rendered Reformation

Chih-Wei Lee; Cheng-Chieh Huang; Yong-Ching Jang; Kuan-Chih Chen; Shang-Yun Ho; Chen-Te Chou; Wen-Pei Wu

doi:10.1016/j.acra.2023.08.037

Diagnostic Accuracy for Acute Rib Fractures: A Cross-sectional Study Utilizing Automatic Rib Unfolding and 3D Volume-Rendered Reformation

Acad Radiol. 2024 Apr;31(4):1538-1547. doi: 10.1016/j.acra.2023.08.037. Epub 2023 Oct 14.

Authors

Chih-Wei Lee¹, Cheng-Chieh Huang², Yong-Ching Jang¹, Kuan-Chih Chen³, Shang-Yun Ho⁴, Chen-Te Chou⁵, Wen-Pei Wu⁶

Affiliations

¹ Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan (C.-W.L., Y.-C.J., S.-Y.H., C.T.C., W.-P.W.).
² Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan (C.-C.H., K.-C.C.); Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (C.-C.H.).
³ Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan (C.-C.H., K.-C.C.).
⁴ Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan (C.-W.L., Y.-C.J., S.-Y.H., C.T.C., W.-P.W.); Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan (S.-Y.H.).
⁵ Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan (C.-W.L., Y.-C.J., S.-Y.H., C.T.C., W.-P.W.); Kaohsiung Medical University, Kaohsiung, Taiwan (C.-T.C., W.-P.W).
⁶ Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan (C.-W.L., Y.-C.J., S.-Y.H., C.T.C., W.-P.W.); Kaohsiung Medical University, Kaohsiung, Taiwan (C.-T.C., W.-P.W); Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (W.-P.W.). Electronic address: wenpei1220@gmail.com.

PMID: 37845164
DOI: 10.1016/j.acra.2023.08.037

Abstract

Rationale and objectives: The aim of this study was to compare the use of computed tomography (CT) with automatic rib unfolding and three-dimensional (3D) volume-rendered imaging in the detection and characterization of rib fractures and flail chest.

Materials and methods: A total of 130 patients with blunt chest trauma underwent whole-body CT, and five independent readers assessed the presence and characterization of rib fractures using traditional CT images, automatic rib unfolding, and 3D volume-rendered images in separate readout sessions at least 2 weeks apart. A gold standard was established by consensus among the readers based on the combined analysis of conventional and reformatted images.

Results: Automatic rib unfolding significantly reduced mean reading time by 47.5%-74.9% (P < 0.0001) while maintaining a comparable diagnostic performance for rib fractures (positive predictive value [PPV] of 82.1%-93.5%, negative predictive value [NPV] of 96.8%-98.2%, and 69.4%-94.2% and 96.9%-99.1% for conventional axial images and 70.4%-85.1% and 95.2%-96.6% for 3D images) and better interobserver agreement (kappa of 0.74-0.87). For flail chest, automatic rib unfolding showed a PPV of 85.7%-100%, NPV of 90.4%-99.0%, and 80.0%-100% and 89.7%-100% for conventional axial images and 76.9%-100% and 89.0%-92.1% for 3D images.

Conclusion: Automatic rib unfolding demonstrated equivalent diagnostic performance to conventional images in detecting acute rib fractures and flail chest, with good interobserver agreement and time-saving benefits.

Keywords: 3-Dimensional imaging; Chest trauma; Computed tomography; Multiplan; Rib fractures; Unfolded ribs.

MeSH terms

Cross-Sectional Studies
Flail Chest*
Humans
Retrospective Studies
Rib Fractures* / diagnostic imaging
Ribs
Thoracic Injuries*
Wounds, Nonpenetrating* / diagnostic imaging