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Delsmann MM, Delsmann J, Jandl NM, Maas KJ, Beil FT, Amling M, Henes FO, Rolvien T, Spink C. Advantages of cone beam computed tomography for evaluation of subchondral insufficiency fractures of the knee compared to MRI. Sci Rep 2024; 14:15278. [PMID: 38961162 PMCID: PMC11222521 DOI: 10.1038/s41598-024-64591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 06/11/2024] [Indexed: 07/05/2024] Open
Abstract
To determine the diagnostic yield of cone beam computed tomography (CBCT) compared with 3 T magnetic resonance imaging (MRI) for the evaluation of subchondral insufficiency fractures of the knee. Consecutive patients with subchondral insufficiency fractures of the knee examined by 3 T MRI and CBCT of the femoral condyles were reviewed. Two experienced raters graded the lesion severity on 3 T MRI and CBCT images: grade 1: no signs of a subchondral bone lesion; grade 2: subchondral trabecular fracture or cystic changes, but without infraction of the subchondral bone plate; grade 3: collapse of the subchondral bone plate. Ratings were repeated after six weeks to determine reliability. In addition, the bone lesion size was measured as elliptical area (mm2) and compared between CBCT and T1-weighted MRI sequences. Among 30 patients included (43.3% women; mean age: 60.9 ± 12.8 years; body mass index (BMI) 29.0 ± 12.8 kg/m2), the medial femoral condyle was affected in 21/30 patients (70%). The grading of subchondral lesions between MRI and CBCT did not match in 12 cases (40%). Based on MRI images, an underestimation (i.e., undergrading) compared with CBCT was observed in nine cases (30%), whereas overgrading occurred in three cases (10%). Compared to CBCT, routine T1-weighted 3 T sequences significantly overestimated osseus defect zones in sagittal (84.7 ± 68.9 mm2 vs. 35.9 ± 38.2 mm2, p < 0.01, Cohen's d = 1.14) and coronal orientation (53.1 ± 24.0 mm2 vs. 22.0 ± 15.2 mm2, p < 0.01, Cohen's d = 1.23). The reproducibility of the grading determined by intra- and inter-rater agreement was very high in MRI (intra-class correlation coefficient (ICC) 0.78 and 0.90, respectively) and CBCT (ICC 0.96 and 0.96, respectively). In patients with subchondral insufficiency fractures of the knee, the use of CBCT revealed discrepancies in lesion grading compared with MRI. These findings are clinically relevant, as precise determination of subchondral bone plate integrity may influence the decision about conservative or surgical treatment. CBCT represents our imaging modality of choice for grading the lesion and assessing subchondral bone plate integrity. MRI remains the gold standard modality to detect especially early stages.
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Affiliation(s)
- Maximilian M Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nico Maximilian Jandl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, BG Hospital Hamburg, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Söderqvist S, Sivonen V, Aarnisalo A, Karppi H, Sinkkonen ST, Koivisto J. OPTIMISING THE PARAMETERS OF COCHLEAR IMPLANT IMAGING WITH CONE-BEAM COMPUTED TOMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2023; 199:462-470. [PMID: 36789742 PMCID: PMC10077498 DOI: 10.1093/rpd/ncad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
With computed tomography (CT), the delicate structures of the inner ear may be hard to visualise, which a cochlear implant (CI) electrode array can further complicate. The usefulness of a novel cone-beam CT device in CI recipient's inner ear imaging was evaluated and the exposure parameters were optimised to attain adequate clinical image quality at the lowest effective dose (ED). Six temporal bones were implanted with a Cochlear Slim Straight electrode array and imaged with six different imaging protocols. Contrast-to-noise ratio was calculated for each imaging protocol, and three observers evaluated independently the image quality of each imaging protocol and temporal bone. The overall image quality of the inner ear structures did not differ between the imaging protocols and the most relevant inner ear structures of CI recipient's inner ear can be visualised with a low ED. To visualise the most delicate structures in the inner ear, imaging protocols with higher radiation exposure may be required.
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Affiliation(s)
| | - Ville Sivonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Aarnisalo
- Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Saku T Sinkkonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Tauno Palva Laboratory, Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Juha Koivisto
- Department of Physics, University of Helsinki, Helsinki, Finland
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Shokri A, Foroozandeh M, Doosti Irani A, Asalian S. Comparison of Diagnostic Quality of Multidetector Computed Tomography and Cone-Beam Computed Tomography in High and Low Resolution Modes for Assessment of the Nasal Cavity. World J Plast Surg 2023; 12:77-89. [PMID: 38130377 PMCID: PMC10732283 DOI: 10.52547/wjps.12.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background We aimed to compare the diagnostic quality of multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) in high (HR) and low (LR) resolution modes for assessment of the nasal cavity and paranasal sinuses. Methods This in vitro study was conducted on 5 dry human skulls by using a CBCT and a MDCT scanner in HR and LR modes to assess their diagnostic quality for 21 anatomical landmarks of the nose. The quality of images was evaluated by two oral and maxillofacial radiologists and a dentist using a four-point Likert scale of (I) poor, (II) decreased, (III) good, and (IV) excellent. Data were analyzed by STATA at 95% confidence interval. The Chi-square test was applied to compare the quality of visualization of landmarks based on the type of scanner. Results The diagnostic quality of HR CBCT and CT for the majority of landmarks was higher than that of LR CBCT and CT (P<0.05). The diagnostic quality of HR CBCT for agger nasi cells (P=0.010), olfactory cleft (P=0.032), sphenoethmoidal recess (P=0.032), and nasolacrimal duct (P=0.014) and LR CBCT for the middle turbinate (P=0.046) and middle meatus (P=0.031) was significantly higher than that of MDCT. Conclusion The diagnostic quality of HR CBCT and CT for the majority of the landmarks in the nasal cavity and paranasal sinuses was higher than that of LR CBCT and CT. For the majority of landmarks, the diagnostic quality of CBCT and CT was the same; while for some landmarks, the diagnostic quality of HR and LR CBCT was higher than HR and LR CT. In general, CBCT has high efficacy for evaluation of the paranasal sinuses and the nasal cavity, and provides diagnostic information comparable to those provided by CT, but with a much lower radiation dose.
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Affiliation(s)
- Abbas Shokri
- Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Foroozandeh
- Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti Irani
- Department of Epidemiology, School of Health Sciences Research Center, Health Sciences & Technology Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shadi Asalian
- Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations-a review of the literature. Skeletal Radiol 2022; 52:1073-1088. [PMID: 36350387 DOI: 10.1007/s00256-022-04223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test-retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements.
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Katlapa A, Kaartinen SM, Henrik Koivisto J, Matikka H. Radiation exposure to fetus from extremity CBCT examinations. Eur J Radiol 2022; 156:110548. [PMID: 36209537 DOI: 10.1016/j.ejrad.2022.110548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate fetal doses from extremity CBCT examinations at different stages of pregnancy and to investigate different methods of fetal dose optimization. METHOD Fetal doses were measured in an anthropomorphic phantom for two CBCT examination protocols - knee and elbow. The measurements were made at three different heights representing the three trimesters during pregnancy and three different depths in the phantom. The effect of soft tissue layer, tube voltage, add-on device shield and body angulation on fetal dose were investigated. RESULTS The fetal doses in clinical examination protocols were in the range of 3.4 to 6.0 µGy during knee examinations and 2.9 to 7.7 µGy during elbow examinations depending on the depth of the fetus and the stage of pregnancy. A soft tissue layer representing variative body composition above abdomen region decreased the fetal dose up to 19 % in knee and up to 21 % in elbow examinations. Using lower tube voltage decreased the fetal doses up to 45 % (knee) and 51 % (elbow). An add-on device shield decreased the fetal doses up to 91 % (knee) and up to 75 % (elbow). Turning the body away from the device bore reduced the fetal doses up to 62 %. The conversion factor to convert an entrance surface dose to the fetal dose ranged from 0.4 to 0.6. CONCLUSIONS The fetal doses from CBCT examinations of extremities are low and do not produce a concern about radiation detriment to the fetus. The most efficient way found to reduce the fetal dose was to use the add-on device shielding.
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Affiliation(s)
- Agnese Katlapa
- Department of Applied Physics, University of Eastern Finland, Yliopistanranta 1 F, 70210, Kuopio, Finland.
| | - Siru M Kaartinen
- Department of Clinical Radiology Kuopio University Hospital Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Juha Henrik Koivisto
- Department of Physics University of Helsinki, Gustaf Hällströmin katu 2, 00560 Helsinki, Finland
| | - Hanna Matikka
- Department of Clinical Radiology Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
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New CBCT Indications in Musculoskeletal Imaging. J Belg Soc Radiol 2021. [DOI: 10.5334/jbsr.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Luetkens KS, Huflage H, Kunz AS, Ritschl L, Herbst M, Kappler S, Ergün S, Goertz L, Pennig L, Bley TA, Gassenmaier T, Grunz JP. The effect of tin prefiltration on extremity cone-beam CT imaging with a twin robotic X-ray system. Radiography (Lond) 2021; 28:433-439. [PMID: 34716089 DOI: 10.1016/j.radi.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/13/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While tin prefiltration is established in various CT applications, its value in extremity cone-beam CT relative to optimized spectra has not been thoroughly assessed thus far. This study aims to investigate the effect of tin filters in extremity cone-beam CT with a twin-robotic X-ray system. METHODS Wrist, elbow and ankle joints of two cadaveric specimens were examined in a laboratory setup with different combinations of prefiltration (copper, tin), tube voltage and current-time product. Image quality was assessed subjectively by five radiologists with Fleiss' kappa being computed to measure interrater agreement. To provide a semiquantitative criterion for image quality, contrast-to-noise ratios (CNR) were compared for standardized regions of interest. Volume CT dose indices were calculated for a 16 cm polymethylmethacrylate phantom. RESULTS Radiation dose ranged from 17.4 mGy in the clinical standard protocol without tin filter to as low as 0.7 mGy with tin prefiltration. Image quality ratings and CNR for tin-filtered scans with 100 kV were lower than for 80 kV studies with copper prefiltration despite higher dose (11.2 and 5.6 vs. 4.5 mGy; p < 0.001). No difference was ascertained between 100 kV scans with tin filtration and 60 kV copper-filtered scans with 75% dose reduction (subjective: p = 0.101; CNR: p = 0.706). Fleiss' kappa of 0.597 (95% confidence interval 0.567-0.626; p < 0.001) indicated moderate interrater agreement. CONCLUSION Considerable dose reduction is feasible with tin prefiltration, however, the twin-robotic X-ray system's low-dose potential for extremity 3D imaging is maximized with a dedicated low-kilovolt scan protocol in situations without extensive beam-hardening artifacts. IMPLICATIONS FOR PRACTICE Low-kilovolt imaging with copper prefiltration provides a superior trade-off between dose reduction and image quality compared to tin-filtered cone-beam CT scan protocols with higher tube voltage.
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Affiliation(s)
- K S Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - H Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - L Ritschl
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - M Herbst
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - S Kappler
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - S Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany.
| | - L Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - L Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - T Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J-P Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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