Abstract
The aim of this study was to evaluate whether diagnosing pulmonary fibrosis with projection radiography can be improved by using X-ray dark-field radiograms. Pulmonary X-ray transmission and dark-field images of C57Bl/6N mice, either treated with bleomycin to induce pulmonary fibrosis or PBS to serve as controls, were acquired with a prototype grating-based small-animal scanner. Two blinded readers, both experienced radiologists and familiar with dark-field imaging, had to assess dark-field and transmission images for the absence or presence of fibrosis. Furthermore readers were asked to grade their stage of diagnostic confidence. Histological evaluation of the lungs served as the standard of reference in this study. Both readers showed a notably higher diagnostic confidence when analyzing the dark-field radiographs (p < 0.001). Diagnostic accuracy improved significantly when evaluating the lungs in dark-field images alone (p = 0.02) or in combination with transmission images (p = 0.01) compared to sole analysis of absorption images. Interreader agreement improved from good when assessing only transmission images to excellent when analyzing dark-field images alone or in combination with transmission images. Adding dark-field images to conventional transmission images in a murine model of pulmonary fibrosis leads to an improved diagnosis of this disease on chest radiographs.
Highlights
In pulmonary fibrosis, healthy lung tissue is destroyed and replaced by connective tissue[1,2]
Since histology showed that the lungs of 7 animals which had received bleomycin did not show any signs of fibrosis, these mice were considered non responders and excluded from the study
Mostly computed tomography (CT)-based imaging approaches for the detection and characterization of chronic pulmonary diseases have emerged during the last few years[15], standard chest radiography is still the most frequently used tool for diagnostic purposes concerning the lung
Summary
Healthy lung tissue is destroyed and replaced by connective tissue[1,2]. As healthy pulmonary tissue yields an exceedingly strong dark-field signal, even small changes in lung structure, for example due to emphysema, lead to a significant decrease in signal strength[9,10]. As a result this may make dark-field imaging more convenient for the detection of pulmonary diseases compared to transmission radiography[11]. Diagnosing fibrosis in vivo compared to conventional X-ray imaging The results of this reader study emphasize the superiority of dark field over transmission imaging as diagnostic accuracy, interreader agreement as well as diagnostic confidence significantly increase when assessing dark-field images
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
