Automatic rib cage unfolding with CT cylindrical projection reformat in polytraumatized patients for rib fracture detection and characterization: Feasibility and clinical application

Abstract Objectives To assess the use of CT with unfolded cylindrical projection (UCP) for rib fracture detection and characterization. Methods The images from 60 polytraumatized patients who underwent whole body CT were evaluated for the presence and characterization of rib fractures (displaced or not, single or multiple). Two readers independently evaluated conventional CT images and UCP images in two readout sessions at least one month apart. All readouts were timed. A gold standard was established by two radiologists with 12 and 22 years of clinical experience based on the combined analysis of conventional and UCP reformats. Results Using UCP, the mean evaluation time was 27%–54% shorter ( P  = 0.01 and 80%). There were more false positives and false negatives using UCP and displaced fractures were harder to characterize. Conclusion UCP yielded a diagnostic performance similar to that of conventional reformats for the detection of rib fractures with a good reproducibility and a noticeable reduction in evaluation time.