Oblique Axis Rib Stretch and Curved Planar Reformats in Patients for Rib Fracture Detection and Characterization: Feasibility and Clinical Application.

Abstract

To assess the use of CT with oblique axis rib stretch (OARS) and curved planar reformats (CPRs) for rib fracture detection and characterization. A total of 108 forensically diagnosed patients with rib fractures were evaluated retrospectively. OARS and CPRs were independently used during the diagnosis in two groups. In each group, the final diagnosis was made after a junior radiologist's initial diagnosis was reviewed by a senior radiologist. The images were evaluated for the presence and characterization of rib fractures. A total of 2,592 ribs were analyzed, and 326 fractured ribs and 345 fracture sites were diagnosed using reference standard. Two groups of radiologists identified 331 and 333 fracture sites using the OARS method, 291 and 288 fracture sites using the CPRs method, and 274 fracture sites in forensically diagnosed patients (CR: conventional reconstruction), respectively; and all missed diagnoses were nondisplaced rib fractures. The ROC Az value of OARS1,2 was 0.98, which is higher than CPRs1,2 0.91, and CR 0.90 (all p < 0.01). The Az value for detecting rib fractures using CPRs1,2 and CR has no statistical difference (p = 0.14 and 0.29). More misdiagnosed patients were found using CPRs1,2 (42 and 44 cases) than OARS1,2 (1 and 2 cases) and CR (2 cases). The displaced fracture detection ratio of all methods showed no difference. Doctors using the OARS method could improve diagnostic performance for detecting rib fractures without the requirement of specialized software and workstation when compared with CPRs.