“This pattern can be explained by several anatomical and technical factors inherent to thoracic CT imaging. The mid-rib region corresponds to the most curved and obliquely oriented portion of the ribs, where the transition from posterior to lateral arc occurs. This complex geometry leads to increased partial volume effects, which may obscure small cortical lesions, particularly on axial images,” noted study authors Derya Karabulut, MD, and Aykut Alkan, MD, who are associated with the Department of Radiology at Trakya University in Edirne, Turkey.
Improving Detection of Smaller Metastatic Lesions with CT Bone Reading Software
Detection of smaller metastatic lesions was also improved with the CT bone reading software with both radiologist readers having a 5 mm median minimum detectable lesion size in contrast to 8 mm and 7 mm, respectively, without the software.
“These findings indicate that CT bone reading software improves the detection of smaller lesions that may be overlooked on standard CT evaluation,” added Drs. Karabulut and Alkan.
Three Key Takeaways
• Rib-reading software catches metastases that standard CT misses. When radiologists added CT bone reading software (syngo.via) to their review, metastatic lesion detection improved by 22.5 percent for one reader and 8.3 percent for the other. Many of the extra lesions were in the mid-rib (about half of the additional finds for each reader). That curved, oblique segment is prone to partial volume effects on axial images, so it deserves extra attention on routine reads, according to the study authors.
• Smaller lesions became visible. With the software, the median smallest detectable lesion was 5 mm for both readers, down from 8 mm and 7 mm without it. Picking up smaller lesions could affect staging and treatment decisions in patients with breast cancer.
• Reading time dropped sharply, but the findings need confirmation. Interpretation time fell by about 50 percent for one reader and 71 percent for the other, largely because the software labels rib levels and shows all ribs in a single plane. This could help in high-volume practices. However, the study was retrospective and single-center with only two reviewing radiologist readers. Prior systemic treatment may have changed how lesions looked, and automated rib segmentation may be less reliable when there are severe artifacts or extensive metastases.
Does Adjunctive CT Bone Reading Software Reduce Reading Time for Radiologists?
Use of the adjunctive CT bone reading software led to a nearly 50 percent reduction of interpretation time for one reader (from 129.22 seconds to 64.94 seconds) and a 71 percent reduction of reading time for the other reviewing radiologist (from 64.44 seconds to 18.71 seconds).
“The bone reading software's ability to label the levels of the ribs and evaluate all ribs in a single plane was the most important factor in shortening the time. This substantial time saving is clinically relevant, particularly in high-volume settings, and supports the integration of such tools into routine radiological workflows,” emphasized Drs. Karabulut and Alkan.
(Editor’s note: For related content, see “Study Suggests Benefits of FDG PET/CT for Detecting Oligometastatic Breast Cancer,” “Current Perspectives on PET/CT Imaging in Patients with Metastatic Breast Cancer” and “PET/CT Shows Superior Results for Detecting Oligometastatic Breast Cancer in Comparison to CT.”)
Beyond the inherent limitations of a single-center retrospective study, the authors acknowledged that that thoracic CT and PET/CT exams were not performed concurrently for every case. They also noted that the appearance of metastatic lesions on CT may have been impacted by prior systemic treatments given that patients who had bone metastases detected during follow-up exams were included in the cohort. The study authors cautioned that the reliability of automated rib segmentation with CT may be compromised in cases involving severe artifacts and extensive metastases.
