E. De Smet

Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma

ObjectiveTo compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma.Materials and methodsBetween March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared.ResultsFracture detection on CBCT increased by 35xa0% and 37xa0% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236xa0% and 185xa0%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT.ConclusionCBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Direct comparison of conventional radiography and cone beam computed tomography in trauma of small bones and joints

21st Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Riga, Latvia, June 26–28, 2014