Color postprocessing of conventional CT images: preliminary results in assessment of nondisplaced proximal femoral fractures

Emerg Radiol. 2018 Dec;25(6):639-645. doi: 10.1007/s10140-018-1626-7. Epub 2018 Jul 14.


Purpose: The purpose of this study was to demonstrate the diagnostic performance and effect on reader confidence of a custom computed tomography (CT) color postprocessing algorithm for assessment of nondisplaced proximal femoral fractures.

Materials and methods: Four radiologists, including two PGY-3 radiology residents and two emergency radiologists, independently interpreted 30 CT examinations of the hip and/or pelvis performed for trauma, consisting of a total of 15 cases positive for nondisplaced hip fracture and 15 age and sex-matched controls. Images were reviewed first with conventional CT images and after at least 8 weeks, all images were reviewed again with the addition of coronal color postprocessed images. Sensitivity and specificity were compared with McNemar's test, and diagnostic confidence was compared with paired t tests.

Results: There was no significant difference in diagnostic performance between conventional and postprocessed images, although there was nominally increased sensitivity and decreased specificity with the postprocessed images: for all readers, the sensitivity and specificity for conventional images was 88.3 and 95.0%, compared to 93.3% (p = 0.25) and 88.3% (p = 0.14) for postprocessed images. Three of four readers (including both attending radiologists) reported an increase in confidence with postprocessed images for cases negative for fracture (10-point confidence scale of 7.25 for conventional images, compared to 8.2 for postprocessed images for all readers, p = 0.0053). There was no difference in diagnostic confidence for cases positive for fracture.

Conclusions: A custom color CT postprocessing algorithm did not demonstrate a significant difference in diagnostic performance for assessment of nondisplaced proximal femoral fractures within the limitations of a relatively small sample size; however, postprocessing increases confidence of experienced readers in cases negative for fracture.

Keywords: CT postprocessing; Hip trauma; Nondisplaced hip fracture; Reader confidence.

MeSH terms

  • Algorithms*
  • Case-Control Studies
  • Color*
  • Femoral Fractures / diagnostic imaging*
  • Humans
  • Radiographic Image Interpretation, Computer-Assisted / methods*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed*