Partial volume effect on kidney stones and lung nodules in CT imaging

Rationale and Objectives: To examine the impact of the partial volume effect (PVE) on the imaging of spherical objects depending on their size, density and center voxel position. Materials and Methods: We developed an algorithm for calculating the volume of a sphere wrapped by voxels. The algorithm measured the internal volume of each voxel cut by the sphere and automatically attributed the average voxel density. The sphere volume was simulated by the sum of voxels with an average density above the Hounsfield Unit (HU) cutoff level for that object. Various sphere sizes, densities and positions in the voxel grid were examined. The two clinical settings used were nodules (0 HU) in the lung (−1000 HU) and kidney stones (1000 HU) embedded in the renal parenchyma (30 HU). Results: Small kidney stones appeared magnified by the PVE when a stone cutoff level of 130 HU was used: the smallest stone simulated with a diameter of 1.4 mm demonstrated a volume that was 231% the size of the ground truth (sphere volume as measured with the classical formula). A hypothetical stone of 10 cm would still have a PVE of 2%. The PVE did not affect lung nodules if the cutoff level for the nodule fraction was set to the exact mean of both the internal and external density (−500 HU). Lung nodules were more affected by the geometrical effect, where tiny nodules appeared smaller because of the greater curvature of smaller spheres, often cutting less than 50% of the volume of a surface voxel. Conclusions: This study highlights the potential risks associated with inaccurate raw data postprocessing of CT images with objects that are particularly sensitive to the PVE, such as kidney stones and high-density calcifications (Agatston score).