@misc{meinel_diagnosing_and_2013, 
author={Meinel, F.G.,Schwab, F.,Schleede, S.,Bech, M.,Herzen, J.,Achterhold, K.,Auweter, S.,Bamberg, F.,Yildirim, A.Oe.,Bohla, A.,Eickelberg, O.,Loewen, R.,Gifford, M.,Ruth, R.,Reiser, M.F.,Pfeiffer, F.,Nikolaou, K.},
title={Diagnosing and Mapping Pulmonary Emphysema on X-Ray Projection Images: Incremental Value of Grating-Based X-Ray Dark-Field Imaging},
year={2013},
howpublished = {journal article},
doi = {https://doi.org/10.1371/journal.pone.0059526},
abstract = {Purpose,To assess whether grating-based X-ray dark-field imaging can increase the sensitivity of X-ray projection images in the diagnosis of pulmonary emphysema and allow for a more accurate assessment of emphysema distribution.,Materials and Methods,Lungs from three mice with pulmonary emphysema and three healthy mice were imaged ex vivo using a laser-driven compact synchrotron X-ray source. Median signal intensities of transmission (T), dark-field (V) and a combined parameter (normalized scatter) were compared between emphysema and control group. To determine the diagnostic value of each parameter in differentiating between healthy and emphysematous lung tissue, a receiver-operating-characteristic (ROC) curve analysis was performed both on a per-pixel and a per-individual basis. Parametric maps of emphysema distribution were generated using transmission, dark-field and normalized scatter signal and correlated with histopathology.,Results,Transmission values relative to water were higher for emphysematous lungs than for control lungs (1.11 vs. 1.06, p<0.001). There was no difference in median dark-field signal intensities between both groups (0.66 vs. 0.66). Median normalized scatter was significantly lower in the emphysematous lungs compared to controls (4.9 vs. 10.8, p<0.001), and was the best parameter for differentiation of healthy vs. emphysematous lung tissue. In a per-pixel analysis, the area under the ROC curve (AUC) for the normalized scatter value was significantly higher than for transmission (0.86 vs. 0.78, p<0.001) and dark-field value (0.86 vs. 0.52, p<0.001) alone. Normalized scatter showed very high sensitivity for a wide range of specificity values (94% sensitivity at 75% specificity). Using the normalized scatter signal to display the regional distribution of emphysema provides color-coded parametric maps, which show the best correlation with histopathology.,Conclusion,In a murine model, the complementary information provided by X-ray transmission and dark-field images adds incremental diagnostic value in detecting pulmonary emphysema and visualizing its regional distribution as compared to conventional X-ray projections.},
note = {Online available at: \url{https://doi.org/10.1371/journal.pone.0059526} (DOI). Meinel, F.; Schwab, F.; Schleede, S.; Bech, M.; Herzen, J.; Achterhold, K.; Auweter, S.; Bamberg, F.; Yildirim, A.; Bohla, A.; Eickelberg, O.; Loewen, R.; Gifford, M.; Ruth, R.; Reiser, M.; Pfeiffer, F.; Nikolaou, K.: Diagnosing and Mapping Pulmonary Emphysema on X-Ray Projection Images: Incremental Value of Grating-Based X-Ray Dark-Field Imaging. PLoS One. 2013. vol. 8, no. 3, e59526. DOI: 10.1371/journal.pone.0059526}}