The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis

Abstract

Objective Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity. Materials and methods We conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC). Results We identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6–93.6) sensitive and 99.2% (95% CI 92.6–99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7–97.2) and 100% (95% CI 99–100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67–98) and specificity was 100% (95% CI 10–100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82–0.96), which is deemed to be almost perfect. Conclusion CBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.

Image quality and patient satisfaction in cone-beam and multidetector computed tomography of the wrist: a randomized trial

“…Dedicated musculoskeletal CBCT might therefore be an alternative to MDCT in CT diagnostics of the wrist, especially if MDCT scanners are not available. For some specific indications, such as the diagnosis of radiocarpal fractures including suspected scaphoid fractures, dedicated musculoskeletal CBCT already showed high sensitivity and specificity for fracture diagnosis and follow-up and therefore appears to be a promising procedure [8,26,27]. In single studies, CBCT shows promising results not only in the assessment of traumatic changes such as fractures, but also osteoarthritisrelated subchondral bone changes and fracture healing [28].…”

Digitale Volumentomografie bei der Behandlung von Radiusfrakturen

“…Neuere Designs ermöglichen die Erweiterung auf andere Körperregionen. Der Einsatz der DVT für Handgelenk und Hand ist noch relativ neu, rückt aber zunehmend in den Fokus [28][29][30][31].…”