Comparison of Cone-Beam Computed Tomography and Multislice Computed Tomography in the Assessment of Extremity Fractures

Abstract

Objectives The aims of this study were to evaluate the agreement between cone-beam computed tomography (CBCT) and multislice computed tomography for the characterization of extremity fractures and to compare image quality, radiation dose, and patient tolerance. Methods Thirty-six patients with suspected fracture affecting distal extremities or who required preoperative fracture assessment were enrolled prospectively. Each patient underwent CBCT and multislice computed tomography the same day. Both examinations were evaluated independently twice by 2 trained radiologists using the Müller AO classification for fracture characterization. Results Cohen κ coefficient for agreement between the imaging techniques was almost perfect for fracture characterization, κ = 0.94 [95% confidence interval, 0.91–0.98]. There was substantial to almost perfect agreement for secondary findings. Cone-beam computed tomography was well tolerated and significantly less irradiant and had better subjective image. Conclusions An excellent agreement between both imaging techniques was found. This confirms the ability of CBCT to assess fractures and its potential in the management of patients with distal limb trauma.

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

“…Historically, this decision-making process has been dominated by concern for the negative sequelae of a non-union fracture [36,37] and, when initial radiographs are equivocal or in case of complex fractures (articular involvement or fragments angulation-dislocation), further multiplanar, high-resolution imaging with CT can be needed [16,17,20,21]. The choice between CBCT and MSCT may be justified by costs and performance characteristics: CBCT is a more cost-effective diagnostic modality due to high sensitivity and lower costs compared with MSCT [17][18][19]22]. The sensitivity and specificity of MSCT and CBCT are both very high.…”

“…The prevalence of finger fracture and performance characteristics of imaging studies were derived from published information [1,2,18,19]. Performance characteristics and utility values of cross-sectional imaging were derived from published information: MSCT sensitivity in the diagnosis of finger fractures is 94% and specificity is 92% [18][19][20][21]. Sensitivity and specificity for CBCT amount to 91% and 93%, respectively [18,19,22,[25][26][27].…”

“…It can, however, be useful in assessment of articular surface involvement for detection of small bone fragments and in case of joint subluxation [6,7,10,16]. Moreover, advanced imaging techniques are mandatory in case of equivocal findings depicted on initial radiographs [17][18][19]. In addition, malunion, delayed union, and non-union can be usually better assessed with MSCT [17][18][19][20].…”

“…Moreover, advanced imaging techniques are mandatory in case of equivocal findings depicted on initial radiographs [17][18][19]. In addition, malunion, delayed union, and non-union can be usually better assessed with MSCT [17][18][19][20]. Currently, MSCT is superior to CR in demonstrating intra-articular fracture lines and in the accuracy of fracture measurements (helpful in preoperative planning) because of slice thickness, isotropic, high-resolution multiplanar reconstruction (MPR) [16,17,21,22].…”

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

“…For example, a study by Dubreuil et al. compared image quality and radiation dose between cone-beam CT and multislice CT [ 47 ]. They found that cone-beam CT delivered significantly less radiation to the patient (average CTDI 2.8 mGy vs 13.1 mGy) than multislice CT while providing high-enough-quality images for fracture classification [ 47 ].…”