Grunz Jan-Peter, Pennig Lenhard, Fieber Tabea, Gietzen Carsten Herbert, Heidenreich Julius Frederik, Huflage Henner, Gruschwitz Philipp, Kuhl Philipp Josef, Petritsch Bernhard, Kosmala Aleksander, Bley Thorsten Alexander, Gassenmaier Tobias
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Eur Radiol. 2021 Jun;31(6):3600-3609. doi: 10.1007/s00330-020-07563-5. Epub 2020 Dec 5.
Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy.
Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard.
CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35-0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83-0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3-5.3 μSv] compared to 0.2 μSv [0.1-0.2 μSv] for radiography.
CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact.
• With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.
在传统放射摄影中，四肢创伤评估可能具有挑战性。具有锥束CT（CBCT）选项的多用X射线系统有助于在不重新定位的情况下进行辅助三维成像。我们通过分析额外发现对治疗的影响来评估CBCT扫描的临床价值。
92例患者接受了放射摄影，随后使用双机器人扫描仪进行CBCT成像（76例腕部/手部/手指和16例踝部/足部/脚趾创伤扫描）。比较了CBCT前后值班放射科医生关于骨折检测、关节受累、粉碎性损伤和诊断信心的报告。骨科医生根据报告结果推荐治疗方案。手术报告（N = 52）和临床随访（N = 85）用作参考标准。
与放射摄影相比，CBCT检测到更多骨折（85例中的83/64）、关节受累（71例中的69/53）和多碎片情况（70例中的68/50）（所有p < 0.001）。CBCT排除了放射片中怀疑的6处骨折。29例患者（31.5%）根据CBCT的额外信息建议改变治疗方案。虽然CBCT前建议的治疗与实际治疗之间的一致性中等（κ = 0.41 [95%置信区间0.35 - 0.47]；p < 0.001），但CBCT后的一致性几乎完美（κ = 0.88 [0.83 - 0.93]；p < 0.001）。CBCT研究的诊断信心显著提高（p < 0.001）。CBCT的中位有效剂量为4.3 μSv [3.3 - 5.3 μSv]，而放射摄影为0.2 μSv [0.1 - 0.2 μSv]。
CBCT在评估急性小骨和关节创伤方面具有优势，比放射片更可靠地检测和排除四肢骨折及与骨折相关的发现。额外发现导致三分之一的患者改变治疗方案，表明具有重大临床影响。
• 使用锥束CT，与传统放射摄影相比，四肢骨折及与骨折相关的发现能够被更可靠地检测和排除。• 锥束CT扫描提供的额外诊断信息对小骨和关节创伤的治疗有重大影响。• 对于远端肢体损伤评估，使用双机器人X射线系统进行一站式成像且无需重新定位是可行的。
