Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA.
Department of Orthopaedic Surgery, University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA, USA.
Pediatr Radiol. 2020 Mar;50(3):363-370. doi: 10.1007/s00247-019-04548-5. Epub 2019 Nov 19.
Pediatric elbow fractures are common but remain challenging to accurately diagnose. Digital tomosynthesis is a technique that has shown promise in difficult adult fracture patterns but has not been formally studied in the pediatric population.
To assess the added value of digital tomosynthesis on the detection and diagnostic confidence of pediatric elbow fractures.
A retrospective study was performed between January 2016 and December 2017 in pediatric patients (≤18 years) to assess the ability of conventional elbow radiographs and digital tomosynthesis to detect elbow fractures. One hundred twenty-one pediatric patients with concern for pediatric elbow trauma (64 males, 57 females; mean age: 8.1 years, range: 1 year to 17 years) were imaged with both conventional elbow radiographs and digital tomosynthesis. Two blinded pediatric radiologists identified fractures and indicated their diagnostic confidence. Observer agreement was assessed with Cohen's Kappa coefficient and a nonparametric Wilcoxon rank sum test was used to compare the degree of diagnostic confidence between standard radiographs alone and standard radiographs with digital tomosynthesis. McNemar's test was used to assess the difference in the rate of fracture detection between the two methods and sensitivity, specificity, precision, accuracy and diagnostic odds ratios were calculated.
Compared with standard radiographs alone, standard radiographs with digital tomosynthesis improved inter-rater agreement, sensitivity, specificity, accuracy, precision and the diagnostic odds ratio for fracture detection and increased diagnostic confidence (Rater 1: P=0.01, Rater 2: P=0.003).
The addition of digital tomosynthesis with conventional elbow radiographs improves diagnostic confidence and performance for the detection of pediatric elbow fractures.
小儿肘部骨折较为常见，但准确诊断仍具挑战性。数字断层合成技术在成人复杂骨折模式中显示出良好的效果，但尚未在儿科人群中进行正式研究。
评估数字断层合成技术在检测和诊断小儿肘部骨折方面的附加价值。
本回顾性研究于 2016 年 1 月至 2017 年 12 月期间在儿科患者（≤18 岁）中进行，以评估常规肘部 X 线片和数字断层合成技术检测肘部骨折的能力。121 例疑似小儿肘部创伤的患儿（64 例男性，57 例女性；平均年龄 8.1 岁，范围 1 岁至 17 岁）均接受了常规肘部 X 线片和数字断层合成技术检查。两名盲法小儿放射科医生识别骨折并表示其诊断信心。采用 Cohen's Kappa 系数评估观察者间一致性，采用非参数 Wilcoxon 秩和检验比较单独标准 X 线片和标准 X 线片加数字断层合成技术的诊断信心程度。采用 McNemar 检验评估两种方法的骨折检出率差异，计算灵敏度、特异度、精准度、准确度和诊断优势比。
与单独使用标准 X 线片相比，标准 X 线片加数字断层合成技术提高了观察者间一致性、灵敏度、特异度、准确度、精准度和骨折检出的诊断优势比，并增加了诊断信心（观察者 1：P=0.01，观察者 2：P=0.003）。
在常规肘部 X 线片中加入数字断层合成技术可提高小儿肘部骨折的诊断信心和检出性能。
