Leeds and West Yorkshire Radiology Academy, B Floor, Clarendon Wing, Leeds General infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Leeds and West Yorkshire Radiology Academy, B Floor, Clarendon Wing, Leeds General infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Clin Imaging. 2022 Mar;83:65-71. doi: 10.1016/j.clinimag.2021.12.014. Epub 2021 Dec 30.
Scaphoid fractures are challenging to accurately diagnose with delayed and missed diagnoses risking poor patient outcomes. Cone beam CT (CBCT) is an emerging technology facilitating alternative access to multi-planar imaging. The aim of this study was to evaluate the use of early CBCT in the diagnosis of suspected scaphoid fractures presenting via the Emergency Department (ED).
In this single centre the imaging pathway was adapted to include early CBCT in adult patients with a persisting high index of clinical suspicion for scaphoid fracture despite normal radiographs. Evaluation of referrals between September 2019 and February 2020 was undertaken. Statistical analysis and temporal pathway metrics were assessed including interrater agreement for CBCT and radiography examinations.
Over the six-month timeframe 100 CBCT wrist scans were performed on 99 adult patients. 94% of CBCT scans were performed within 1 day of referral. 25% of scans demonstrated acute injuries including 12 radius, 6 trapezium and 2 scaphoid fractures. For fracture, CBCT had a sensitivity of 96.2% and specificity of 100%. There was a highly significant difference in interobserver variation between fracture detection on CBCT and radiographs.
CBCT heralds the potential for early accurate diagnosis of radiocarpal fractures, at lower cost, shortening clinical pathways and reducing clinical risk in the ED.
舟状骨骨折的诊断具有挑战性，延迟和漏诊会导致患者预后不良。锥形束 CT（CBCT）是一种新兴技术，可提供多平面成像的替代途径。本研究旨在评估在急诊科（ED）就诊的疑似舟状骨骨折患者中早期使用 CBCT 的效果。
在这个单中心研究中，对 2019 年 9 月至 2020 年 2 月期间的转诊患者进行了评估，改变了影像学检查途径，纳入了对 CBCT 有持续高临床怀疑但 X 线片正常的成人患者。对转诊患者进行了评估。统计分析和时间路径指标进行了评估，包括 CBCT 和 X 线摄影检查的观察者间一致性。
在六个月的时间内，对 99 例成年患者进行了 100 次 CBCT 腕部扫描。94%的 CBCT 扫描在转诊后 1 天内进行。25%的扫描显示急性损伤，包括 12 例桡骨、6 例舟骨和 2 例舟骨骨折。对于骨折，CBCT 的敏感性为 96.2%，特异性为 100%。骨折在 CBCT 和 X 线摄影上的检测存在高度显著的观察者间差异。
CBCT 有望在 ED 以更低的成本、更短的临床路径和降低临床风险，实现早期准确诊断腕骨骨折。
