Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Bavaria, Germany.
Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany.
Acad Radiol. 2023 Jul;30(7):1358-1366. doi: 10.1016/j.acra.2022.08.030. Epub 2022 Sep 25.
Gantry-free cone-beam CT (CBCT) allows for comfortable patient positioning due to an open scanner architecture. Since CBCT without gantry is not yet established for clinical wrist trauma imaging, this study's aim was to investigate its diagnostic value in the preoperative workup of patients with distal radius and scaphoid fractures.
Within a 12-month period, 113 patients with severe wrist trauma underwent both radiography and CBCT with the same gantry-free multi-use scanner before surgery. Two radiologists retrospectively analyzed all datasets for the morphology of distal radius (n = 95) and scaphoid fractures (n = 20). In all 115 wrists (two bilateral injuries), surgical reports served as the standard of reference.
While accuracy for distal radius fractures was comparable among CBCT and radiographs, the former was superior with regard to scaphoid fractures (Reader 1: 100.0% vs. 75.0%; Reader 2: 100.0% vs. 65.0%). Accuracy for multi-fragmentary radius injuries (100.0% vs. 90.5%; 100.0% vs. 93.7%), and articular affliction (99.0% vs. 84.2%; 100.0% vs. 83.2%) was also higher in CBCT. Regarding scaphoid fractures, CBCT proved superior for diagnosis of proximal pole or waist involvement (100.0% vs. 70.0%; 100.0% vs. 65.0%) and comminuted patterns (100.0% vs. 70.0%; 100.0% vs. 75.0%). Median effective dose of CBCT was as low as 3.65 µSv compared with 0.16 µSv for standard radiography.
Gantry-free CBCT allows for excellent diagnostic accuracy in the assessment of distal radius and scaphoid fracture morphology. Even in patients with limited mobility, very low radiation dose is sufficient to maintain high image quality.
无机架锥形束 CT（CBCT）由于采用开放式扫描仪结构，因此允许患者舒适地定位。由于无机架 CBCT 尚未在临床腕关节创伤成像中确立，因此本研究旨在探讨其在桡骨远端和舟状骨骨折患者术前评估中的诊断价值。
在 12 个月的时间内，113 例严重腕部创伤患者在手术前均使用相同的无机架多用扫描仪进行放射摄影和 CBCT 检查。两名放射科医生回顾性分析了所有 95 例桡骨远端和 20 例舟状骨骨折的数据集。在所有 115 个腕关节（两个双侧损伤）中，手术报告均作为参考标准。
虽然 CBCT 和 X 线摄影对桡骨远端骨折的准确性相当，但前者对舟状骨骨折的准确性更高（读片 1：100.0%比 75.0%；读片 2：100.0%比 65.0%）。多段桡骨损伤（100.0%比 90.5%；100.0%比 93.7%）和关节受累（99.0%比 84.2%；100.0%比 83.2%）的准确率在 CBCT 中也更高。对于舟状骨骨折，CBCT 在诊断近极或腰部受累（100.0%比 70.0%；100.0%比 65.0%）和粉碎性骨折（100.0%比 70.0%；100.0%比 75.0%）方面表现更优。与标准放射摄影相比，CBCT 的有效辐射剂量中位数仅为 3.65µSv，而标准放射摄影的有效辐射剂量为 0.16µSv。
无机架 CBCT 可在评估桡骨远端和舟状骨骨折形态方面提供出色的诊断准确性。即使在活动受限的患者中，极低的辐射剂量也足以保持高图像质量。
