title: 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.
abstract: OBJECTIVE
  To investigate the performance of a new CT software generating rib unfolded images for improved detection of rib osteolyses in patients with multiple myeloma.
  
  
  METHODS
  One hundred sixteen patients who underwent whole-body reduced-dose multidetector computed tomography (WBRD-MDCT) for multiple myeloma diagnosis and during follow-up were retrospectively evaluated. Nonenhanced CT scans with 5- and 1-mm slice thickness were interpreted by two readers with focus on detection of rib involvement (location, number, fracture). Image analysis of "unfolded," 1-mm-based CT rib images was subsequently undertaken. We classified the number of lytic bone lesions into 0, 1, 2, <5, <10 and ≥10. For all three data sets the reading time was registered.
  
  
  RESULTS
  An approximated sum of 6,727 myeloma-related rib lesions was found. On a patient-based analysis, CT (5 mm), CT (1 mm) and CT (1 mm "unfolded rib") yielded a sensitivity, specificity and accuracy of 79.7/94.7/87.1, 88.1/93/90.5 and 98.3/96.5/97.4, respectively. In a lesion-based analysis, the sensitivity, specificity and accuracy of the three evaluations were 69.7/87.2/70.5, 79.8/55.9/78 and 96.5/89.7/96.1. Mean reading time for 5 mm/1 mm axial images and unfolded images was 178.7/215.1/90.8 s, respectively.
  
  
  CONCLUSIONS
  The generation of "unfolded rib" images improves detection of rib involvement in patients with multiple myeloma and significantly reduces reading time.
authors.affiliation: Department of diagnostic and interventional radiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany, georghomann@web.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Homann
authors.forename: Katja
authors.initials: K
authors.lastname: Weisel
authors.forename: Deedar Farhad
authors.initials: DF
authors.lastname: Mustafa
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ditt
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012272:Ribs / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012984:Software; D012986:Software Validation; D014057:Tomography, X-Ray Computed / Q000379:methods*
references.citation: Eur J Radiol. 2005 May;54(2):289-97
references.pmid: 15837412
references.citation: Eur J Nucl Med Mol Imaging. 2006 May;33(5):525-31
references.pmid: 16453155
references.citation: Br J Radiol. 2008 May;81(965):386-96
references.pmid: 18440943
references.citation: Skeletal Radiol. 2009 Mar;38(3):225-36
references.pmid: 19009290
references.citation: PLoS One. 2012;7(12 ):e52213
references.pmid: 23300617
references.citation: Acad Radiol. 2015 Apr;22(4):505-12
references.pmid: 25586709
references.citation: Cancer. 2007 Apr 15;109 (8):1617-26
references.pmid: 17330855
references.citation: Eur Radiol. 2008 Jan;18(1):51-8
references.pmid: 17924119
references.citation: Eur J Radiol. 2013 Dec;82(12 ):2322-7
references.pmid: 24074647
references.citation: Mayo Clin Proc. 2003 Jan;78(1):21-33
references.pmid: 12528874
references.citation: Clin Imaging. 2007 Jul-Aug;31(4):225-7
references.pmid: 17599614
references.citation: Am J Med. 1993 Jan;94(1):57-61
references.pmid: 8420300
references.citation: Ann Oncol. 2005 Aug;16(8):1223-31
references.pmid: 15928069
references.citation: Br J Haematol. 2013 Jul;162(1):50-61
references.pmid: 23617231
references.citation: J Comput Assist Tomogr. 2007 May-Jun;31(3):342-7
references.pmid: 17538276
references.citation: Eur J Radiol. 2014 Jul;83(7):1222-1230
references.pmid: 24793843
references.citation: Ann Hematol. 2009 Dec;88(12 ):1161-8
references.pmid: 19763570
references.citation: Cancer. 1975 Sep;36(3):842-54
references.pmid: 1182674
references.citation: Hematology Am Soc Hematol Educ Program. 2008;:313-9
references.pmid: 19074102
references.citation: Br J Haematol. 1999 Jul;106(1):35-9
references.pmid: 10444160
references.citation: AJR Am J Roentgenol. 2014 Jan;202(1):170-9
references.pmid: 24370141
references.citation: Haematologica. 2007 Jan;92(1):50-5
references.pmid: 17229635
references.citation: Eur J Haematol. 1991 Nov;47(5):338-41
references.pmid: 1761119
references.citation: Cancer Invest. 2013 Mar;31(3):206-11
references.pmid: 23406213
references.citation: AJR Am J Roentgenol. 2005 Apr;184(4):1199-204
references.pmid: 15788594