Comparison of 3D X-ray tomography with computed tomography in patients with distal extremity fractures
Comparison of 3D X-ray tomography with computed tomography in patients with distal extremity fractures
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DOI：
10.1007/s00256-020-03508-7
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发表时间：
2020-06-18
影响因子：
2.1
通讯作者：
Hirschmann, Anna
中科院分区：
文献类型：
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作者：
Falkowski, Anna L.;Kovacs, Balazs K.;Hirschmann, Anna
目的比较3D断层扫描和计算机断层扫描（CT）在四肢远端骨折患者中的骨折检测、图像质量和辐射剂量。材料和方法获得IRB批准，包括2016年6月至12月本前瞻性研究的知情同意书。在同一天使用3D断层扫描对CT诊断为急性骨折的患者进行连续扫描。由两名设盲的阅片员采用5分制Likert量表独立评估骨折的解剖位置（受影响骨和骨内位置）和形态学特征（撕脱、关节受累、单碎片与多碎片、移位）、骨/软组织结构的可见性和图像质量。比较两种模式的剂量长度乘积（DLP; mGy*cm）。计算描述性统计、Wilcoxon符号秩和检验（P < 0.05）、Student t检验（P < 0.05）和Cohen的kappa（kappa）。结果46例患者（男28例，女18例;平均年龄53 ± 20岁）共行28次手/腕关节和18次足/踝关节检查，92例骨折中，86例经3D断层扫描与CT对比确诊。3D断层扫描未出现假阳性结果。在3D断层扫描上漏诊的6处骨折分别为5处腕骨/掌骨或跗骨/跖骨撕脱性骨折和1处头状骨非移位性骨折。上肢（kappa = 0.80-0.96）和下肢（kappa = 0.70-0.97）骨折的解剖位置和形态特征的阅片者间一致性基本上接近完美。3D断层扫描对骨和软组织结构的显示及图像质量略差于CT（上肢P < 0.001-0.038，下肢P < 0.001-0.035）。对于上肢（3D平均值，19.4 +/- 5.9 mGy*cm;估计的CT平均值，336.5 +/- 52.2 mGy*cm）和下肢（3D平均值，24.1 +/- 11.1 mGy*cm;估计的CT平均值，182.9 +/- 6.5 mGy*cm）的3D断层扫描，可比扫描覆盖范围的DLP显着较低（P < 0.001）。即使使用3D断层扫描的最高DLP也<可比覆盖区域的平均估计CT剂量的30%。结论利用低剂量三维断层X线系统对四肢骨折进行评估是可靠的，图像质量略有下降。
Objective To compare fracture detection, image quality, and radiation dose in patients with distal extremity fractures using 3D tomography and computed tomography (CT). Materials and methods IRB approval was obtained including informed consent for this prospective study from June to December 2016. Patients diagnosed with an acute fracture at CT were consecutively scanned on the same day using 3D tomography. Anatomical location (effected bone and location within the bone) and morphological characteristics of fractures (avulsion, articular involvement, mono- vs. multifragmented, displacement), visibility of bone/soft tissue structures, and image quality were assessed independently by two blinded readers on a 5-point Likert scale. Dose-length-product (DLP; mGy*cm) was compared between both modalities. Descriptive statistics, Wilcoxon signed rank test (P < 0.05), Student'sttest (P < 0.05), and Cohen's kappa (kappa) for interreader reliability were calculated. Results In 46 patients (28 males; 18 females; mean age, 53 +/- 20 years) with 28 hand/wrist and 18 foot/ankle examinations, 86 out of 92 fractures were diagnosed with 3D tomography compared with CT. No false-positive finding occurred at 3D tomography. The six missed fractures on 3D tomography were five avulsion fractures of the carpals/metacarpals or tarsals/metatarsals, respectively, and one nondisplaced fracture of the capitate. Interreader agreement of anatomical location and morphological characteristics was substantial to almost perfect for upper (kappa = 0.80-0.96) and lower (kappa = 0.70-0.97) extremity fractures. Visibility of bone and soft tissue structures and image quality were slightly inferior using 3D tomography compared with CT (upper extremityP < 0.001-0.038 and lower extremityP < 0.001-0.035). DLP of a comparable scan coverage was significantly lower for 3D tomography (P < 0.001) for both upper (3D mean, 19.4 +/- 5.9 mGy*cm; estimated CT mean, 336.5 +/- 52.2 mGy*cm) and lower extremities (3D mean, 24.1 +/- 11.1 mGy*cm; estimated CT mean, 182.9 +/- 6.5 mGy*cm). Even the highest DLP with 3D tomography was < 30% of the mean estimated CT dose of a comparable area of coverage. Conclusion Fracture assessment of peripheral extremities is reliable utilizing a low-dose 3D tomography X-ray system, with slightly reduced image quality.