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Fig. 1. Postprocessing using multipla-nar intersection with gray scale manip-ulation. After multiplanar-coronal,sagittal and axial-intersection, grayscale manipulation is performed on theintersection plane.

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Fig. 2. Postprocessing using gray scalemanipulation. The initial intersectionplane shows the standard level of grayscale by auto gray scaling. The contrastresolution between the cortex andmedulla on initial intersection plane isnot better than that of bony algorithmon CT scan. On lowering level of grayscale, the contrast resolution betweenthe cortex and medulla is more im-proved than that on standard level ofgray scale.

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C D E F GFig. 3. 37-year-old woman (case No.10) with the fracture (arrow) of left posterior element of C6. The posterior views of 3D CT (A)and sagittal 2D CT scan (C) reveal no evidence of fracture. But, the fracture(arrow) is detectable only on posterior 3D volume (B)and sagittal intersection plane of 3D DRI (D). Axial bone setting window of CT (E) shows the fracture(arrow) suspiciously which isseen on the axial intersection with lower level of gray scaling (F) and standard volume (G) of 3D DRI.

A B

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Table 1. Classification of Fractures on Conventional Radiography, CT (2D or 3D) and 3D DRI

Case No. Fracture site Conventional Radiography CT (2D or 3D) 3D DRI

01 Tibial plateau Type IV Type IV Type IV02 Distal tibia Type III Type III Type III03 Pelvis,acetabulum Type A2,B Type A2,B Type A2,B04 Calcaneus Type E Type E Type E05 Lumbar spine Wedge compression Stable burst Stable burst06 Proximal ulna, coronoid & olecranon - Type II,Type I Type II,Type I07 Carpal,scaphoid - - Type II08 acetabulum Type C Type C Type C09 Cervical spine, odontoid process Type II Type II Type II10 Cervical spine,posterior element - - CE stage I11 Pelvis Type A2 Type A2 Type A212 Lumbar spine Unstable burst Unstable burst Unstable burst13 Cervical spine,odontoid process Type II Type II Type II14 Lumbar spine Unstable burst Unstable burst Unstable burst15 Lumbar spine Wedge compression Wedge compression Wedge compression16 Lumbar spine Wedge compression Wedge compression Wedge compression

Table 2. Detection, Characterization and Comparison ofFractures on Conventional Radiography, 2D or 3D CT and 3DDRI

Case No. Conventional RadiographyCT

3D DRI2D 3D

01 + ++ + +++02 + ++ 0 ++03 + + 0 ++04 ++ +++ + +++05 + ++ + +++06 0 + 0 +++07 0 0 0 +08 + ++ + +++09 + + 0 ++10 0 0 0 ++11 + + 0 ++12 + + 0 ++13 + + ++ +++14 + + + +++15 + + ++ +++16 + + ++ +++

0= poor visualization or disinterpretation+=ambiguous visualization,++=precise visualization+++=more precise visualization)

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Address reprint requests to : Min Hee Lee, M.D., Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan UniversitySchool of Medicine, 50 Ilwon-dong, Kangnam-gu, 135-710 Seoul, Korea.Tel. 82-2-3410-0511 Fax. 82-2-3410-0084 E-mail: mhlee27@hotmail.com

Three Dimensional Digital Rotational Imaging in theEvaluation of the Fractures1

Semin Chong, M.D., Min Hee Lee, M.D.2, Hyon Joo Kwag, M.D., Young Rae Lee, M.D.,Shin-Ho Kook, M.D., Hae Won Park, M.D., Woo-Jin Moon, M.D.,

Seung Kwon Kim, M.D., Eun Chul Chung, M.D.

1Department of Radiology, Kangbuk Samsung Hospital, SungKyunKwan University School of Medicine2Department of Diagnostic Radiology, Samsung Medical Center, SungKyunKwan University School of Medicine

Purpose: To evaluate the usefulness and the application of three dimensional digital rotational imaging (3DDRI) by the evaluation of fractures.Materials and Methods: Sixteen patients with clinically diagnosed or suspicious fracture were involved in thisstudy. The lesion or suspicious sites of all 16 cases were spines (n=7), pelvis (n=3) and so on (n=6; knee, el-bow, ankle, wrist and foot). In all cases, conventional radiography, multiplanar 2D (slice thickness/pitch=3 or5 mm/1:1)and volume rendering 3D reconstructed single detector helical CT (HiSpeed Advantage, GE MedicalSystems, Milwaukee, WIS) scans and 3D DRI (Integris V-5000,Philips Medical Systems, The Netherlands)with multiplanar intersection and gray scaling as postprocessing technique were performed. 3D DRI was eval-uated and compared with conventional radiography, multiplanar 2D CT and volume rendering 3D CT.Results: 3D DRI provided more detail and additional information in 14 cases (88%), comparing with 2D and3D CT scans. Two fractures were revealed only on 3D DRI other than conventional radiography and CT scansand one case was revealed on 2D CT and 3D DRI. In all cases, we could acquired more detail and additionalinformation from 3D DRI than from 3D CT in the acquisition of 3D imaging. 3D DRI didn t change the classi-fication of fracture in 12 of 13 cases (92%),which revealed the fracture on the conventional radiography or CT. Conclusion: 3D DRI can diagnose and evaluate the fracture rapidly and easily with anatomical and spatial res-olution by acquisition of 3D imaging with postprocessing using DRI.

Index words : Bones, fracturesBones, CTComputed tomography (CT), three-dimensionalImages, three-dimensional