From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.).
Radiology. 2023 Mar;306(3):e221200. doi: 10.1148/radiol.221200. Epub 2022 Nov 8.
Background Posttraumatic CT imaging of the elbow can be challenging when patient mobility is limited. Gantry-free cone-beam CT (CBCT) with a twin robotic radiography system offers greater degrees of positioning freedom for three-dimensional elbow scans over gantry-based multidetector CT (MDCT), but studies analyzing their clinical value remain lacking. Purpose To investigate the diagnostic performance of gantry-free CBCT versus two-dimensional radiography in adults and children with acute elbow trauma. Materials and Methods In a retrospective study, consecutive patients with elbow trauma and positioning difficulty in a gantry-based MDCT who underwent three-dimensional elbow imaging with a gantry-free CBCT after radiography were enrolled between January 2021 and April 2022 at a tertiary care university hospital. Imaging data sets were independently analyzed for fracture presence, articular involvement, and multi-fragment injuries by three radiologists. Diagnostic performance was calculated individually with surgical reports serving as the reference standard. Differences between radiography and CBCT were compared with the McNemar test. Diagnostic confidence was estimated subjectively by each reader, and results were compared with the Wilcoxon signed-rank test. Results Elbow examinations of 23 adults and children (mean age ± SD, 49 years ± 23; seven women) were included with individual assessment of humerus, radius, and ulna (69 bones; 36 fractured). Multi-fragmentary fracture patterns and involvement of articular surfaces were ascertained in 28 and 30 bones, respectively. CBCT allowed for similar or higher sensitivity compared with radiography in the assessment of fractures (range for three readers, 94%-100% vs 72%-81%; respectively, ≤ .06-.008), articular surface involvement (90%-97% vs 73%-87%; ≤ .25), and multi-fragmentary patterns (96%-96% vs 68%-75%; ≤ .03). Readers' diagnostic confidence improved considerably with access to CBCT data sets versus radiographs (all ≤ .001). For CBCT, the median dose-length product was 70.9 mGy · cm, and the volume CT dose index was 4.4 mGy. Conclusion In acute elbow injuries, gantry-free cone-beam CT enabled improved detection of fractures, articular involvement, and multi-fragmentary patterns compared with two-dimensional radiography. Published under a CC BY 4.0 license
背景 当患者活动受限时，肘部创伤后的 CT 成像具有挑战性。带有双机器人放射系统的无机架锥形束 CT（CBCT）为三维肘部扫描提供了比基于机架的多探测器 CT（MDCT）更大的定位自由度，但分析其临床价值的研究仍然缺乏。目的 探讨无机架 CBCT 与二维放射摄影在成人和儿童急性肘部创伤中的诊断性能。材料与方法 在一项回顾性研究中，2021 年 1 月至 2022 年 4 月期间，在一家三级护理大学医院，对在基于机架的 MDCT 中存在定位困难的肘部创伤患者进行二维放射摄影后，行三维肘部成像的患者，连续纳入无机架 CBCT。三位放射科医生分别独立分析骨折存在、关节受累和多骨折损伤的影像学数据。单独计算诊断性能，以手术报告作为参考标准。用 McNemar 检验比较放射摄影和 CBCT 之间的差异。每个读者主观估计诊断信心，并与 Wilcoxon 符号秩检验进行比较。结果 共纳入 23 名成人和儿童（平均年龄±标准差，49 岁±23；7 名女性）的肘部检查，分别评估肱骨、桡骨和尺骨（69 块骨；36 块骨折）。多骨折模式和关节面受累分别在 30 块和 28 块骨中确定。与放射摄影相比，CBCT 在评估骨折（三位读者的范围，94%-100%比 72%-81%；分别为≤.06-.008）、关节面受累（90%-97%比 73%-87%；≤.25）和多骨折模式（96%-96%比 68%-75%；≤.03）方面具有相似或更高的敏感性。与仅使用放射摄影相比，读者使用 CBCT 数据集的诊断信心有了显著提高（均为≤.001）。对于 CBCT，剂量长度乘积中位数为 70.9 mGy·cm，容积 CT 剂量指数为 4.4 mGy。结论 在急性肘部损伤中，与二维放射摄影相比，无机架锥形束 CT 能够提高骨折、关节受累和多骨折模式的检出率。
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