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Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone

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Abstract

Subdural hematomas (SDHs) comprise a significant percentage of missed intracranial hemorrhage on axial brain CT. SDH detection rates could be improved with the addition of reformatted images. Though performed at some centers, the potential additional diagnostic sensitivity of reformatted images has not yet been investigated. The purpose of our study is to determine if the addition of coronal and sagittal reformatted images to an axial brain CT increases the sensitivity and specificity for detection of acute traumatic SDH. We retrospectively reviewed consecutive brain CTs acquired for acute trauma that contained new SDHs. An equivalent number of normal brain CTs served as control. Paired sets of images were created for each case: (1) axial images only (“axial only”) and (2) axial, coronal, sagittal images (“reformat added”). Three readers interpreted both the axial only and companion reformat added for each case, separated by 1 month. Reading times and SDH detection rates were compared. One hundred SDH and 100 negative examinations were collected. Sensitivity and specificity for the axial-only scans were 75.7 and 94.3 %, respectively, compared with 88.3 and 98.3 % for reformat added. There was a 24.3 % false negative (missed SDH) rate with axial-only scans versus 11.7 % with reformat added (p = <0.001). Median reader interpretation times were longer with the addition of reformatted images (125 versus 89 s), but this difference was not significant (p = 0.23). The addition of coronal and sagittal images in trauma brain CT resulted in improved sensitivity and specificity as well as a reduction in SDH false negatives by greater than 50 %. Reformatted images substantially reduce the number of missed SDHs compared with axial images alone.

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Acknowledgments

This study was approved by our institutional review board with a waiver of the need to obtain informed consent and was compliant with the Health Insurance Portability and Accountability Act.

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Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center|, Box 3808, Durham, NC, 27710, UK

    Timothy J. Amrhein & Peter G. Kranz

  2. Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 322 169 Ashley Avenue, Charleston, SC, 29425, USA

    Timothy J. Amrhein, William Mostertz, Maria Gisele Matheus, Genevieve Maass-Bolles & Komal Sharma

  3. Department of Radiology, St. Vincent’s Medical Center, Quinnipiac School of Medicine, 2800 Main Street, Bridgeport, CT, 06606, USA

    Komal Sharma

  4. Center for Biomedical Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St., MSC 323, Charleston, SC, 29425-0323, USA

    Heather R. Collins

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  1. Timothy J. Amrhein
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  2. William Mostertz
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  3. Maria Gisele Matheus
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  5. Komal Sharma
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  7. Peter G. Kranz
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Correspondence to Timothy J. Amrhein.

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Amrhein, T.J., Mostertz, W., Matheus, M.G. et al. Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone. Emerg Radiol 24, 39–45 (2017). https://doi.org/10.1007/s10140-016-1440-z

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  • DOI: https://doi.org/10.1007/s10140-016-1440-z

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