Volume rendering of tendon-bone relationships using unenhanced CT

OBJECTIVE. Clinically, three-dimensional CT of the extremities is most often used to display bony anatomy. However, by combining unenhanced CT with volume-rendering computer graphics, visualization of relationships between bone and soft-tissue structures such as muscle and tendon is also possible. The aims of this study were to quantify CT attenuation values of peripheral tendon, muscle, and bone on unenhanced CT and to develop custom opacity transforms on the basis of the attenuation measurements to effectively depict tendon-muscle-bone relationships. CONCLUSION. The mean attenuation of peripheral tendon (∼100 H) is distinctly higher than that of muscle (∼60 H) enabling high-quality volume rendering of muscle-tendon-bone relationships with unenhanced CT. High-frequency (bone) CT reconstruction algorithms commonly used for extremity CT produce approximately twofold higher image noise and inferior three-dimensional renderings compared with those based on less noisy standard or soft-tissue reconstruction algorithms. These concepts can be used to uniquely reveal tendon-muscle-bone relationships for clinical, scientific, and educational purposes.