Comparing the diagnostic performance of radiation dose-equivalent radiography, multi-detector computed tomography and cone beam computed tomography for finger fractures - A phantom study.

PURPOSE: To compare the diagnostic performance and raters´confidence of radiography, radiography equivalent dose multi-detector computed tomography (RED-MDCT) and radiography equivalent dose cone beam computed tomography (RED-CBCT) for finger fractures. METHODS: Fractures were inflicted artificially and randomly to 10 cadaveric hands of body donors. Radiography as well as RED-MDCT and RED-CBCT imaging were performed at dose settings equivalent to radiography. Images were de-identified and analyzed by three radiologists regarding finger fractures, joint involvement and confidence with their findings. Reference standard was consensus reading by two radiologists of the fracturing protocol and high-dose multi-detector computed tomography (MDCT) images. Sensitivity and specificity were calculated and compared with Cochrane´s Q and post hoc analysis. Rater´s confidence was calculated with Friedman Test and post hoc Nemenyi Test. RESULTS: Rater´s confidence, inter-rater correlation, specificity for fractures and joint involvement were higher in RED-MDCT and RED-CBCT compared to radiography. No differences between the modalities were found regarding sensitivity. CONCLUSION: In this phantom study, radiography equivalent dose computed tomography (RED-CT) demonstrates a partly higher diagnostic accuracy than radiography. Implementing RED-CT in the diagnostic work-up of finger fractures could improve diagnostics, support correct classification and adequate treatment. Clinical studies should be performed to confirm these preliminary results.

Comparison of the diagnostic accuracy of cone beam computed tomography and radiography for scaphoid fractures.

The aim of this study was to evaluate and compare the diagnostic accuracy, the inter-rater agreement and raters' certainty of cone beam computed tomography (CBCT) and radiography for the detection of scaphoid fractures. Our hypothesis is that the CBCT has a higher diagnostic accuracy for scaphoid fractures than radiography. We retrospectively analysed patients who underwent both radiography and CBCT examinations within 4 days to rule out a scaphoid fracture over a 2-year period in our institution. 4 blinded radiologists and orthopaedic surgeons independently rated the images regarding the presence of a scaphoid fracture. The reference standard was evaluated by two radiologists in a consensus reading. Inter-rater correlation was evaluated, pooled sensitivity, specificity, positive and negative predictive values were calculated and compared. 102 patients met the inclusion criteria. 52% of them had a scaphoid fracture. The inter-rater correlation was higher in the CBCT compared to radiography (P < 0.001). Sensitivity, specificity, positive and negative predictive values were higher for CBCT than for radiography (P < 0.019). Observers' fracture classifications showed a higher correlation with the reference standard in the CBCT. Observers' certainty for fracture detection and classification were higher in the CBCT. CBCT shows a higher diagnostic accuracy for scaphoid fractures than radiography.