Uterine fibroid embolization with acrylamido polyvinyl microspheres: prospective 12-month clinical and MRI follow-up study.

Background Uterine fibroid embolization (UFE) is an effective minimally invasive treatment aimed to obtain complete fibroid infarction. Purpose To evaluate the degree of fibroid infarction after embolization with acrylamido polyvinyl alcohol microspheres (Bead Block). Material and Methods This prospective study included 26 pre-menopausal women in the period October 2013 to January 2015. UFE with the use of Bead Block microspheres 700-900 µm was obtained until flow stasis was achieved. Contrast-enhanced magnetic resonance imaging (MRI) was used to define residual contrast enhancement in the total fibroid burden and enhancement >10% was defined as insufficient embolization. The dominant fibroid volume and total uterine volume changes were assessed. Clinical outcome was analyzed using the quality of life questionnaire (UFS-QOL). Results Twenty-four of the 26 patients (92%) had a technically successful UFE with complete flow-stop in both uterine arteries. Twenty-two of the 26 patients (85%) completed 3 months of MRI control and 20 patients (77%) completed 12 months of MRI control. There were 16 of 22 patients (73%) with complete fibroid burden infarction and/or without residual contrast enhancement of the fibroids of more than 10% at 3 months of control. Six of 22 patients (27%) had insufficient fibroid burden infarction with residual contrast enhancement of more than 10%. Twenty-two and 18 of 26 patients completed the 3-month and 12-month questionnaire, respectively. UFS-QOL analyses showed that 91% of the patients had significant clinical improvement. Conclusion Sixteen of the 22 patients had complete fibroid burden infarction using Bead Block microspheres (700-900 µm); however, unacceptably high insufficient fibroid burden infarction in almost one-fourth of the patients were recorded.

Recurrent Primary Spontaneous Pneumothorax is Common Following Chest Tube and Conservative Treatment.

INTRODUCTION: Previous studies on primary spontaneous pneumothorax reported variable recurrence rates, but they were based on heterogeneous patient populations including secondary pneumothorax. We investigated young patients with primary spontaneous pneumothorax exclusively and used a national registry to track readmissions and calculate independent predictors of recurrence. METHODS: A prospective cohort study of consecutive young patients who were admitted over a 5-year period with their first episode of primary spontaneous pneumothorax and treated conservatively with a chest tube. Baseline characteristics were obtained from questionnaires presented on admittance. All patients were discharged with fully expanded lungs on chest radiography. Patient charts were identified in the national electronic patient registry for detailed information on readmissions due to recurrent spontaneous pneumothorax. RESULTS: We included 234 patients. Male/female = ratio 5/1. After a median observation period of 3.6 years (range 1-6 years), recurrent pneumothorax was observed in 54 %. Ipsilateral recurrence was the most common (79 %) but 30 % also experienced contralateral pneumothorax during the study period. Females had a significantly higher age at debut (p < 0.01) and experienced significantly more recurrences over time (p < 0.01). Low body weight (<60 kg) was an independent predictor of recurrence and patients with repeated recurrences were significantly younger at debut (p = 0.01). CONCLUSIONS: Primary spontaneous pneumothorax in younger patients with their first episode had a much higher recurrence rate than previously reported. Every doctor who treats patients with primary spontaneous pneumothorax should be aware and patients informed.

Supplementary arteriel embolization an option in high-risk ulcer bleeding--a randomized study.

OBJECTIVE: One of the major challenges in peptic ulcer bleeding (PUB) is rebleeding which is associated with up to a fivefold increase in mortality. We examined if supplementary transcatheter arterial embolization (STAE) performed after achieved endoscopic hemostasis improves outcome in patients with high-risk ulcers. MATERIAL AND METHODS: The study was designed as a non-blinded, parallel group, randomized-controlled trial and performed in a university hospital setting. Patients admitted with PUB from Forrest Ia - IIb ulcers controlled by endoscopic therapy were randomized (1:1 ratio) to STAE of the bleeding artery within 24 h or continued standard treatment. Randomization was stratified according to stigmata of hemorrhage. Patients were followed for 30 days. Primary outcome was a composite endpoint where patients were classified into five groups based on transfusion requirement, development of rebleeding, need of hemostatic intervention and mortality. Secondary outcomes were rebleeding, number of blood transfusions received, duration of admission and mortality. RESULTS: Totally 105 patients were included. Of the 49 patients allocated to STAE 31 underwent successful STAE. There was no difference in composite endpoint. Two versus eight patients re-bled in the STAE and control group, respectively (Intention-to-treat analysis; p = .10). After adjustment for possible imbalances a strong trend was noted between STAE and rate of rebleeding (p = .079). CONCLUSIONS: STAE is potentially useful for preventing rebleeding in high-risk PUB. STAE can safely be performed in selected cases with high risk of rebleeding. Further studies are needed in order to confirm these findings; ClincialTrials.gov number, NCT01125852.

Correction: Abdi et al. Visual Evaluation of Image Quality of a Low Dose 2D/3D Slot Scanner Imaging System Compared to Two Conventional Digital Radiography X-ray Imaging Systems. Diagnostics 2021, 11, 1932.

In the original publication [...].

Quantitative Image Quality Metrics of the Low-Dose 2D/3D Slot Scanner Compared to Two Conventional Digital Radiography X-ray Imaging Systems.

The aim of this study was to determine the quantitative image quality metrics of the low-dose 2D/3D EOS slot scanner X-ray imaging system (LDSS) compared with conventional digital radiography (DR) X-ray imaging systems. The effective detective quantum efficiency (eDQE) and effective noise quantum equivalent (eNEQ) were measured using chest and knee protocols. METHODS: A Nationwide Evaluation of X-ray Trends (NEXT) of a chest adult phantom and a PolyMethylmethacrylate (PMMA) phantom were used for the chest and knee protocols, respectively. Quantitative image quality metrics, including effective normalised noise power spectrum (eNNPS), effective modulation transfer function (eMTF), eDQE and eNEQ of the LDSS and DR imaging systems were assessed and compared. RESULTS: In the chest acquisition, the LDSS imaging system achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.044). For the knee acquisition, the LDSS imaging system also achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.002). However, there was no significant difference in eNEQ and eDQE between DR systems 1 and 2 at lower and higher spatial frequencies (0.10 < p < 1.00) for either chest or knee protocols. CONCLUSION: The LDSS imaging system performed well compared to the DR systems. Thus, we have demonstrated that the LDSS imaging system has the potential to be used for clinical diagnostic purposes.

Visual Evaluation of Image Quality of a Low Dose 2D/3D Slot Scanner Imaging System Compared to Two Conventional Digital Radiography X-ray Imaging Systems.

The purpose of this study was to assess the image quality of the low dose 2D/3D slot scanner (LDSS) imaging system compared to conventional digital radiography (DR) imaging systems. Visual image quality was assessed using the visual grading analysis (VGA) method. This method is a subjective approach that uses a human observer to evaluate and optimise radiographic images for different imaging technologies. METHODS AND MATERIALS: ten posterior-anterior (PA) and ten lateral (LAT) images of a chest anthropomorphic phantoms and a knee phantom were acquired by an LDSS imaging system and two conventional DR imaging systems. The images were shown in random order to three (chest) radiologists and three experienced (knee) radiographers, who scored the images against a number of criteria. Inter- and intraobserver agreement was assessed using Fleiss' kappa and weighted kappa. RESULTS: the statistical comparison of the agreement between the observers showed good interobserver agreement, with Fleiss' kappa coefficients of 0.27-0.63 and 0.23-0.45 for the chest and knee protocols, respectively. Comparison of intraobserver agreement also showed good agreement with weighted kappa coefficients of 0.27-0.63 and 0.23-0.45 for the chest and knee protocols, respectively. The LDSS imaging system achieved significantly higher VGA image quality compared to the DR imaging systems in the AP and LAT chest protocols (p < 0.001). However, the LDSS imaging system achieved lower image quality than one DR system (p ≤ 0.016) and equivalent image quality to the other DR systems (p ≤ 0.27) in the knee protocol. The LDSS imaging system achieved effective dose savings of 33-52% for the chest protocol and 30-35% for the knee protocol compared with DR systems. CONCLUSIONS: this work has shown that the LDSS imaging system has the potential to acquire chest and knee images at diagnostic quality and at a lower effective dose than DR systems.

The effect of transcatheter arterial embolisation for nonvariceal upper gastrointestinal bleeding.

INTRODUCTION: The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy. MATERIAL AND METHODS: Between 2007 and 2009, transcatheter arterial embolisation was performed in 40 patients. We evaluated the angiographic and clinical success rate, recurrent bleeding rate, procedure-related complications and clinical outcomes. RESULTS: Primary technical success was achieved in all patients. In 82% of the patients, haemostasis was achieved with clinical improvement and without need for further therapy. There were no ischaemic GI complications. Recurrent bleeding occurred in seven patients (18%) within the first week after treatment, and in three cases these were managed successfully with a second embolisation. The overall 30-day mortality rate was 18%, and mortality related to bleeding was 10%. The mean follow-up period was 13 months (range 1-31 months). Non-bleeding-related mortality was 15% in the follow-up period. There were no hospital readmissions due to upper GI bleeding. CONCLUSION: Transcatheter arterial embolisation for upper GI bleeding is a safe and effective minimally invasive method, but it entails relatively high rates of early rebleeding as well as relatively high mortality rates both related to GI bleeding and to non-GI bleeding causes.

Intra-arterial lidocaine administration during uterine fibroid embolization to reduce the immediate postoperative pain: a prospective randomized study.

BACKGROUND: To investigate if intra-arterial lidocaine administrated immediately after the embolisation endpoint reduces the pain. METHODS: Forty patients were randomised and 36 completed the study for purposes of analysis. In one group, the patients got 1% 10 ml lidocaine (100 mg) administered into each uterine artery immediately after embolisation with microspheres. The other group was embolised without supplementary lidocaine. The patients scored their pain on a visual analogue scale (VAS) 2 h, 4 h, 7 h, 10 h and 24 h after embolisation, and the total amount of used morphine was noted. Three-month follow-up MRI control was scheduled for all the patients to investigate the infarction rate. RESULTS: Embolisation was performed without any complications and with embolisation of both uterine arteries in all cases. Intra-arterial lidocaine was administered in all 20 patients without complications, and 20 patients in a control group did not receive lidocaine intra-arterial. VAS schemes showed a significant reduction in pain experience 2 h after UFE where mean pain score in the lidocaine group was 42.7 ± 21.4 compared with the control group in which the mean pain score was 61.1 ± 20.4 (p < 0.02). There was no significant difference in pain score 4 h, 7 h, 10 h and 24 h after UFE. In the lidocaine group, the mean amount of used morphine was significantly less with 11.2 mg compared with 20.2 mg in the control group (p < 0.03). Three months of MR follow-up control showed no significant difference in the grade of fibroid infarction. CONCLUSION: Intra-arterial Lidocaine administration after embolisation is safe and effective in reducing post-procedural pain in the early hours and opioid usage in the first 24 h following UAE.

Correction to: Preliminary experience with the micro vascular plug for the treatment of pulmonary arteriovenous malformation: case series of four patients.

In the published article (Duvnjak et al. 2018) the statement under the subheading 'Consent for publication' is incorrect.

Long-Term Single-Center Retrospective Follow-Up After Embolization of Pulmonary Arteriovenous Malformations Treated Over a 20-year Period: Frequency of Re-canalization with Various Embolization Materials and Clinical Outcome.

PURPOSE: The present study is a register-based observational study of an unselected consecutive patient cohort with pulmonary arteriovenous malformations (PAVMs) from a single national hereditary hemorrhagic telangiectasia and PAVM embolization center. The aim was to investigate the frequency of re-embolizations and the clinical outcome after embolization with the use of different embolization materials further, to define which PAVM morphology and size of feeding arteries that most often were re-embolized, and to estimate the clinical outcome of the patients including those that were re-embolized. METHODS: The population was included from 1996 until 2016 and was made up of a total of 136 patients with 322 PAVMs. Median follow-up was 38.3 (0.3-241 months). RESULTS: The re-embolization rate was 9.3%. None of the PAVMs treated with detachable silicone balloons were re-embolized, while 4.5% treated with vascular plugs and 11.7% treated with coils were re-embolized (p=0.07). In total, 16/74 complex PAVMs were re-embolized compared with 14/248 simple PAVMs. In big-sized feeding arteries ≥ 6mm, 16/112 were re-embolized compared with 14/210 with smaller-sized feeding arteries. Out of the 30 re-embolized PAVMs, 23 resulted in a successful clinical outcome. CONCLUSIONS: Our results suggest that standard coils probably should not be the first choice for embolization of PAVMs, and vascular plug alone or in combination with coils might be a better primary option for embolization in these patients. LEVEL OF EVIDENCE: Level 3A, non-randomized case controlled cohort/follow-up study.

COMPARISON OF RADIATION EXPOSURE TO THE PATIENT AND CONTRAST DETAIL RESOLUTIONS ACROSS LOW DOSE 2D/3D SLOT SCANNER AND TWO CONVENTIONAL DIGITAL RADIOGRAPHY X-RAY IMAGING SYSTEMS.

PURPOSE: To assess and compare the radiation dose and image quality of the low dose 2D/3D EOS slot scanner (LDSS) to conventional digital radiography (DR) X-ray imaging systems for chest and knee examination protocols. METHODS AND MATERIALS: The effective doses (ED) to the patient in the chest and knee clinical examination protocols for LDSS and DR X-ray imaging systems were determined using the dose area product and PCXMC Monte Carlo simulation software. The CDRAD phantom was imaged with 19 cm, and 13 cm thick Polymethyl Methacrylate (PMMA) blocks to simulate the chest and knees respectively of a patient of average adult size. The contrast detail resolution was calculated using image analysis software. RESULTS: The EDs for the LDSS default setting were up to 69% and 51% lower than for the DR systems for the chest (speed 4) and knee (speed 6) protocols, respectively, while for the increased dose level setting then the EDs were up to 42% and 35% lower than for the DR systems for the chest (speed 6) and knee (speed 8) protocols respectively. At the default setting, the contrast detail was lowest for the default setting of the 2D/3D low dose slot scanner (LDSS) for both chest and knee examinations, but at the highest dose levels then the threshold were equal or higher than the contrast resolution of DR imaging systems. CONCLUSION: The LDSS has the potential to be used for clinical diagnosis of chest and knee examinations using the higher dose level. For speed 6 in chest protocol and speed 8 in knee protocol, the measured contrast detail resolution was comparable with the DR systems but at a lower effective dose.

Incidence of primary spontaneous pneumothorax: a validated, register-based nationwide study.

OBJECTIVES: The incidence of primary spontaneous pneumothorax is partly unknown. Commonly quoted estimates were published decades ago and recent large-scale epidemiological publications lack validation. We validated the pneumothorax diagnosis in a national registry and estimated the incidence of primary spontaneous pneumothorax in young patients. METHODS: Complete data on patients with an assigned pneumothorax diagnosis was retrieved from the National Danish Patient Registry. Initially, we validated the diagnosis in a selected population: all patient charts with an assigned pneumothorax diagnosis from one cardiothoracic department over a 25-year period (1984-2008) were reviewed. Subsequently, the national incidence of primary spontaneous pneumothorax in young, healthy individuals was estimated by restricting our population to patients ≤40 years of age admitted during a 5-year period (2009-2014). We performed a systematic read-though of patient charts in 50% of the complete national cohort to ensure that we only included patients with their first episode of primary spontaneous pneumothorax. RESULTS: Validation revealed a poor inter-rater agreement (κ=0.08). Therefore, we abstained from further analysis on directly retrieved data from the national database. Subsequently, a systematic re-evaluation of 7022 patients revealed an incidence rate of 12.3 cases per 100 000 (95% CI 11.5-13.1) in males and 2.2 cases per 100 000 (95% CI 1.9-2.6) in females (male/female ratio 5.9). Compared with the general Danish population, pneumothorax patients had a lower body mass index (p<0.001) and smoked more than the Danish population in general (p<0.001). CONCLUSIONS: The incidence of primary spontaneous pneumothorax in a validated national study was lower than previously reported.

Bone density measurements adjacent to acetabular cups in total hip arthroplasty using dual-energy CT: an in vivo reliability and agreement study.

BACKGROUND: Measuring bone mineral density (BMD) around acetabular prosthetic components with computed tomography (CT) is challenged by the complex anatomy and metal artifacts. Three-dimensional (3D) segmentation is required for the analysis, but it is usually not practically applicable on current CT workstations. PURPOSE: To test the between-scan agreement and reliability of custom segmentation software for BMD measurements adjacent to cemented and uncemented acetabular cups in dual-energy CT (DECT). MATERIAL AND METHODS: Twenty-four male patients with total hip arthroplasty were scanned and rescanned using 130-keV virtual monochromatic DECT images. Hemispherical regions of interest were defined slice-by-slice and BMD was calculated around the acetabular cup using custom segmentation software. RESULTS: In the uncemented cup, the mean BMD was 153 mg/cm3 with a between-scan difference of 10 mg/cm3 (P < 0.0001). In the cemented cup, the mean BMD was 186 mg/cm3 with a between-scan difference of 6 mg/cm3 (P = 0.15). In both uncemented and cemented cups the intraclass correlation coefficient between repeated measurements was >0.95 and narrow Bland-Altman Limits of Agreement. CONCLUSION: BMD can be measured with high absolute between-scan agreement and good reliability adjacent to acetabular cemented and uncemented cups using DECT and segmentation software.

Preliminary experience with the micro vascular plug for the treatment of pulmonary arteriovenous malformation: case series of four patients.

BACKGROUND: To describe the preliminary experience using Micro Vascular Plug (MVP) for treatment of pulmonary arteriovenous malformations (PAVMs) with small feeding arteries (3 -5 mm) in four patients with Hereditary Haemorrhagic Telangiectasia (HHT). MATERIAL AND METHODS: One female and three male patients with PAVMs have been treated during 2017. The mean age was 32.5 years; (range: 20-53). All patients underwent contrast echocardiography and computed tomography of the chest to establish the diagnosis. RESULTS: Four patients with PAVMs were treated with embolisation using the MVP-3Q and MVP-5Q micro plugs. All MVP were placed without complications and with following immediate occlusion of the PAVMs in all three cases. In one case MVP was placed semi selectively. All cases were with the good clinical outcomes. CONCLUSION: MVP is a new detachable embolisation material which is easy to use. Maximal control during the deployment and immediate occlusion of the target vessels can be achieved.

Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial.

OBJECTIVES: Primary spontaneous pneumothorax frequently recurs after chest tube management. Evidence is lacking whether patients may benefit from surgery following their first episode. METHODS: We performed a multicentre, randomized trial and enrolled young, otherwise healthy patients admitted with their first episode of primary spontaneous pneumothorax and treated using conventional chest tube drainage. Patients underwent high-resolution computed tomography on fully expanded lungs, and using web-based randomization, we assigned patients to continued conservative chest tube treatment or chest tube treatment followed by video-assisted thoracoscopic surgery (VATS) with the resection of bullae/blebs and mechanical pleurodesis. Patients were stratified into 2 groups based on the presence of bullae ≥1 cm on high-resolution computed tomography. The primary end point was readmission with ipsilateral recurrence. Secondary end points were complications and length of hospitalization. RESULTS: Between 1 August 2009 and 4 November 2016, we screened 457 patients, of whom 373 were eligible for inclusion and 181 were enrolled: male/female ratio = 5.0. We identified 88 patients with blebs <1 cm: 50 were randomly assigned to chest tube treatment and 38 to VATS. Ninety-three patients had bullae ≥1 cm: 43 were randomly assigned to chest tube treatment and 50 to VATS. Forty-three (23.8%) patients experienced recurrence during the follow-up period. Overall, recurrence was significantly lower following VATS when compared with conventional chest tube treatment (P = 0.0012). When stratified by bullae size, VATS proved significantly better for bullae ≥1 cm (P = 0.014). We observed a size-response relationship with increased risk of recurrence for larger bullae (P = 0.013). CONCLUSIONS: Surgery was an effective treatment to prevent recurrence in patients with their first presentation of primary spontaneous pneumothorax and should be the standard of care when high-resolution computed tomography demonstrates bullae ≥2 cm. Clinical trial registration: ClinicalTrial.gov: NCT 02866305.

[Interventional radiology in minimally invasive treatments].

Interventional radiology (IR) is a fast expanding field which includes vascular (arterial and venous) as well as non-vascular topics. IR is minimally invasive methods, which are performed under guidance of radiological modalities. The methods are in general patient-friendly and organ-sparing procedures and can often be performed on out-patient basis or with short admission to the hospital and with short reconvalescence and economic advantages compared with corresponding surgical treatments. IR has in some cases substituted former surgical procedures. Technological development has facilitated increasing IR treatment offers and indications, and there is a high level of evidence for many of the offers.

Magnetic Resonance Signal Intensity Ratio Measurement Before Uterine Artery Embolization: Ability to Predict Fibroid Size Reduction.

PURPOSE: To evaluate whether the magnetic resonance imaging (MRI) signal intensity (SI) ratio between the dominant fibroid and the periphery striated muscle can predict fibroid volume reduction >50% after uterine fibroid embolization (UFE). MATERIALS AND METHODS: From October 2013 until May 2016, 52 patients were included in this prospective study. The SI ratio before UFE was calculated using circular region of interests placed on the dominant fibroid and the iliac muscle. The SI fibroid-to-iliac muscle ratio was calculated as SI of the dominant fibroid/SI of the iliac muscle on T1-, T2-, and T1 post-contrast-weighted sequences. The dominant fibroid volume was measured and analyzed before and after UFE. RESULTS: In all, 46 patients who completed the three-month follow-up MRI were available for analysis. The correlation between SI fibroid-to-muscle ratio at the T2-weighted sequence and imaging volume reduction outcome was statistically significant (p < 0.002). All other parameters showed no statistically significant reduction in fibroid volume: (p < 0.68) for SI ratio at T1-weighted, (p < 0.13) for SI ratio at T1 post-contrast, and (p < 0.58) for fibroid volume. Spearman's rank showed positive correlation (r = 0.439, p < 0.003) between the fibroid-to-muscle SI ratio on T2-weighted sequence. The area under curve (AUC) for SI fibroid-to-muscle ratio on T2-weighted sequence was 0.776. For the other parameters, the AUC values were 0.512, 0.671, and 0.578, respectively. CONCLUSION: SI dominant fibroid-to-muscle ratio at T2-weighted sequence before UFE was significantly related to dominant fibroid volume reduction after UFE and may be used for better patient selection.

[Polyorchidism is a rare cause of a scrotal mass].

In this case report we present a 14-year-old boy with two testicles in the right hemiscrotum - a case of polyorchidism. He did not have surgery for his condition, and his condition was followed according to the guidelines. In a study, 6.4% of cases with polyorchidism were found to contain neoplasms of which the most were malignant. If the supernumerary testicle is not contributing to the spermatogenesis, it is therefore recommended to remove the testicle. Otherwise, recommendations are a yearly follow-up by Doppler ultrasound, including a physical examination to discover development of cancer.

Intra- and inter-observer agreement and reliability of bone mineral density measurements around acetabular cup: a porcine ex-vivo study using single- and dual-energy computed tomography.

BACKGROUND: Periprosthetic bone loss is considered to be a potentially contributing factor in aseptic loosening of acetabular hip components, but no studies have shown this association. The lack of association might be caused by insufficient image quality because of metal artifacts and challenges in measuring bone density (BMD) in complex anatomic structures which might be overcome using dual-energy computed tomography (DECT). PURPOSE: To test inter- and intra-observer agreement and reliability of in-house segmentation software measuring BMD adjacent to acetabular cup and to compare measurements performed with single-energy CT (SECT) and DECT in cemented and cementless cups. MATERIAL AND METHODS: Twenty-four acetabular cups inserted in porcine hip specimens were scanned with SECT and DECT. Bone density was measured in a three-dimensional volume adjacent to the cup. Double measurements were performed. RESULTS: BMD derived from SECT was approximately four times higher than that of DECT. In both scan modes, intraclass correlation coefficient (ICC) was >0.90 with no differences between repeated measurements, except for uncemented cups where a statistically significant difference of 11 mg/cm3 was found with DECT. DECT showed narrower limits of agreement than SECT. Inter-observer analysis showed small differences. CONCLUSION: BMD can be estimated with high intra- and inter-observer reliability with SECT and DECT around acetabular cups using custom software. The intra- and inter-observer agreement of DECT is superior to that of SECT and better in the cementless concept. Good intra- and inter-observer reliability can be obtained in both cemented and cementless cups using the segmentation software. SECT and DECT cannot be used interchangeably.