Single-shot CT after wrist trauma: impact on detection accuracy and treatment of fractures

Abstract

Objective To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT protocol as a primary imaging tool in all patients with clinical suspicion of wrist injury, and evaluate the resulting impact on therapy. Materials and methods We performed a single-institution study on all patients with suspicion of fractures of the wrist and carpus. All patients underwent conventional radiography, thereafter single-shot wrist CT, and then 1-year follow-up. Physicians and radiologists prospectively scored likelihood of fracture presence on a five-point scale before and after CT. Three surgeons proposed a treatment regimen (functional, cast, reduction, or operative) based on clinical and radiological data, first with knowledge of conventional radiography, and then with knowledge of CT. The reference standard for fracture presence was based on all data. We performed receiver operating characteristic (ROC) analyses and calculated proportion of wrists with treatment changes due to CT imaging. Results Ninety-eight patients participated (63% female, mean age 53, range, 18–87 years old) with 100 wrist CTs. Conventional radiography detected true-positive fractures in 45, and CT in 61 wrists. The areas under the curve for fracture detection were 0.85 (95% CI 0.77–0.93) for conventional radiography and 0.97 (95% CI 0.93–1.00) for CT. Treatment changed in 24 (24%, 95% CI 16–33%) - 31 (31%, 95% CI 23–41%) wrists, mostly involving a decrease in the rate of cast immobilization. Conclusions Single-shot CT in patients with clinical suspicion of wrist injury increases accuracy of fracture detection. This has a significant impact therapy in this population, mainly on cast immobilization. Trial Registration We registered the study at www.clinicaltrials.gov , NL43482.091.13.

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

“…ULD-CT significantly increased the overall fracture detection rate-in 36 extremities (36/207; 17.4%) a fracture was detected with ULD-CT where DR failed to detect a fracture. The diagnostic findings are concordant with a previous study comparing the accuracy of fracture detection between a low-dose CT protocol and conventional radiography for wrist trauma [12]. However, our study has further evaluated the diagnostic performance of a low-dose CT protocol to also include ankle and midfoot trauma, as well as workflow parameters.…”

“…Clinical studies have shown that implementation of ASIR-V can decrease the mean RD between 34 and 35% while maintaining image quality [13,14]. Previously reported mean RD for low-dose CT evaluation of fractures of the peripheral skeleton has been in the range of 10-800 μSv [12,[15][16][17][18] and for cone-beam CT (CBCT) in the range of 0.9-14.3 μSv [19]. Our ULD-CT protocol has, to our knowledge, the lowest reported mean RD (0.59 μSv) for the peripheral skeleton in the literature, corresponding to around 1.7 h of exposure to background radiation [20].…”

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

“…Physicians should be aware that tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tubercle and pain on longitudinal compression of the thumb have limited added value in a diagnostic process for a scaphoid fracture. The present systematic review identified eight supplementary imaging studies [58,61,65,66,[68][69][70]74], subdivided into MRI [66], CT [58,66,[68][69][70], BS [66] and US [61,65,74]. The overall conclusion is that imaging tests were found to be moderately accurate for a definitive diagnosis.…”

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

“…To our knowledge, all first authors of those five studies were working in a hospital care setting, so we assume all to have been done in hospital care. History taking, physical examination and imaging as index tests were nvestigated in 0%, 20% (7/35) [43, 44, 46, 47, 67 71, 74] and 86% (30/35) [75][76][77] of the studies, respectively.…”

“…In 13 of the 35 studies [43,44,51,53,56,57,59,61,62,70,71,73,74], patient selection was not well documented. Furthermore, the risk of bias was predominantly due to the absence of a proper description of the index test (9/35) [43,47,49,51,55,57,61,65,71] or the reference standard (13/35) [43,46,49,51,52,55,57,65,67,69,72,74,75]. Twelve of the studies (34%) demonstrated no limitations when risk of bias was assessed, according to QUADAS-2 [45,48,50,54,58,60,63,64,66,68,76,77].…”