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Kunz AS, Schmalzl J, Huflage H, Luetkens KS, Patzer TS, Kuhl PJ, Gruschwitz P, Petritsch B, Schmitt R, Bley TA, Grunz JP. Twin Robotic Gantry-Free Cone-Beam CT in Acute Elbow Trauma. Radiology 2023; 306:e221200. [PMID: 36346312 DOI: 10.1148/radiol.221200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Posttraumatic CT imaging of the elbow can be challenging when patient mobility is limited. Gantry-free cone-beam CT (CBCT) with a twin robotic radiography system offers greater degrees of positioning freedom for three-dimensional elbow scans over gantry-based multidetector CT (MDCT), but studies analyzing their clinical value remain lacking. Purpose To investigate the diagnostic performance of gantry-free CBCT versus two-dimensional radiography in adults and children with acute elbow trauma. Materials and Methods In a retrospective study, consecutive patients with elbow trauma and positioning difficulty in a gantry-based MDCT who underwent three-dimensional elbow imaging with a gantry-free CBCT after radiography were enrolled between January 2021 and April 2022 at a tertiary care university hospital. Imaging data sets were independently analyzed for fracture presence, articular involvement, and multi-fragment injuries by three radiologists. Diagnostic performance was calculated individually with surgical reports serving as the reference standard. Differences between radiography and CBCT were compared with the McNemar test. Diagnostic confidence was estimated subjectively by each reader, and results were compared with the Wilcoxon signed-rank test. Results Elbow examinations of 23 adults and children (mean age ± SD, 49 years ± 23; seven women) were included with individual assessment of humerus, radius, and ulna (69 bones; 36 fractured). Multi-fragmentary fracture patterns and involvement of articular surfaces were ascertained in 28 and 30 bones, respectively. CBCT allowed for similar or higher sensitivity compared with radiography in the assessment of fractures (range for three readers, 94%-100% vs 72%-81%; respectively, P ≤ .06-.008), articular surface involvement (90%-97% vs 73%-87%; P ≤ .25), and multi-fragmentary patterns (96%-96% vs 68%-75%; P ≤ .03). Readers' diagnostic confidence improved considerably with access to CBCT data sets versus radiographs (all P ≤ .001). For CBCT, the median dose-length product was 70.9 mGy · cm, and the volume CT dose index was 4.4 mGy. Conclusion In acute elbow injuries, gantry-free cone-beam CT enabled improved detection of fractures, articular involvement, and multi-fragmentary patterns compared with two-dimensional radiography. Published under a CC BY 4.0 license Online supplemental material is available for this article.
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Affiliation(s)
- Andreas Steven Kunz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Jonas Schmalzl
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Henner Huflage
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Karsten Sebastian Luetkens
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Theresa Sophie Patzer
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Philipp Josef Kuhl
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Philipp Gruschwitz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Bernhard Petritsch
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Rainer Schmitt
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Thorsten Alexander Bley
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Jan-Peter Grunz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
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