title: Image Quality Required for the Diagnosis of Skull Fractures Using Head CT: A Comparison of Conventional and Improved Reconstruction Kernels.
abstract: OBJECTIVE
  Although skull fractures are generally assessed on bone images obtained by using head CT, the combined multikernel technique that enables evaluation of both brain and bone through a change in the window settings of an image set has been reported. The purpose of this retrospective study was to determine the image quality required for the accurate assessment of skull fractures by using head CT.
  
  
  METHODS
  A random sample of 50 patients (25 nonfracture and 25 simple nondisplaced skull fractures) was selected, and sets of conventional brain and bone images and improved combined multikernel images were reconstructed (4614 images). Three radiologists indicated their confidence levels regarding the presence of skull fractures by marking on a continuous scale for each image set. The mean area under the receiver operating characteristic curve was calculated for each kernel, and the statistical significance of differences was tested by using the Dorfman-Berbaum-Metz method.
  
  
  RESULTS
  Although a difference in the diagnostic performance of the 3 radiologists was suggested, the mean area under the curve value showed no significant differences among the 3 reconstruction kernels (P= .95 [bone versus combined]),P= .91 [bone versus brain]), andP= .88 [brain versus combined]). However, the quality of brain images was distinctly poorer than the quality of the other 2 images.
  
  
  CONCLUSIONS
  There was no significant difference in the diagnostic performance of brain, bone, and combined multikernel images for skull fractures. Skull fracture diagnosis is made possible by brain image assessments. Combined multikernel images offer the advantage of high-quality brain and bone images.
authors.affiliation: From the Faculty of Health Sciences (S.T.), Hokkaido University, Hokkaido, Japan rt.stakagi@gmail.com.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-9931-0815
authors.initials: S
authors.lastname: Takagi
authors.affiliation: Radiological Center (M.K.), National Defense Medical College Hospital, Saitama, Japan.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-8532-9478
authors.initials: M
authors.lastname: Koyama
authors.affiliation: Department of Radiology (K.H., T.K.), National Defense Medical College, Saitama, Japan.
authors.forename: K
authors.identifier: http://orcid.org/0000-0003-1092-2546
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Radiology (K.H., T.K.), National Defense Medical College, Saitama, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-8918-9265
authors.initials: T
authors.lastname: Kawauchi