Postoperative Extremity Tomosynthesis-A Superimposition-Free Alternative to Standard Radiography?

IF 7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Investigative Radiology Pub Date : 2024-11-01 Epub Date: 2024-05-07 DOI:10.1097/RLI.0000000000001085

Jan-Peter Grunz, Andreas Steven Kunz, Mila Marie Paul, Karsten Sebastian Luetkens, Henner Huflage, Nora Conrads, Süleyman Ergün, Thomas Weber, Magdalena Herbst, Sophia Herold, Thorsten Alexander Bley, Theresa Sophie Patzer

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Abstract

Rationale and objectives: This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms.

Materials and methods: After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement.

Results: Radiation dose in radiography was 0.48 ± 0.26 dGy·cm 2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm 2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms ( P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols ( P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P 's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis ( P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598-0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599-0.903), implant positioning (ICC, 0.855; 95% CI, 0.729-0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556-0.934).

Conclusions: In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.

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术后四肢断层摄影--标准放射摄影的无叠加替代品？

理由和目的：本研究调查了在存在骨合成植入物的情况下断层合成的性能，旨在克服传统射线照片中叠加引起的局限性：在手术诱导骨折并随后进行骨合成后，使用多用途 X 光系统的原型断层合成模式扫描 8 个尸体骨折模型（腕部、掌骨、踝关节、跖骨）。将 60、80 和 116 kV（扫描角度 10°，13 FPS）的断层合成方案与标准射线照片进行了比较。五位放射科医生根据等距 7 分制独立评定诊断可评估性，重点是骨折划线、关节内螺钉置入和植入物定位。通过计算类内相关系数（ICC）来分析医生间的一致性：结果：在 60、80 和 116 千伏电压下，放射摄影的辐射剂量为 0.48 ± 0.26 dGy-cm2，而断层扫描的辐射剂量分别为 0.12 ± 0.01、0.36 ± 0.02 和 1.95 ± 0.11 dGy-cm2。与射线照片相比，80/116 千伏断层扫描对骨折线的描述更清晰（P ≤ 0.003）。对关节内螺钉置放的评估在所有断层扫描方案中都是有利的（P ≤ 0.004），而对植入物定位的评估则无法确定其优劣（所有 P 均≥ 0.599）。80/116 kV断层扫描的诊断可信度高于放射摄影和60 kV断层扫描（P≤0.002）。在骨折分界（ICC，0.803；95% 置信区间[CI]，0.598-0.904）、关节内螺钉置入（ICC，0.802；95% CI，0.599-0.903）、植入物定位（ICC，0.855；95% CI，0.729-0.926）和诊断可信度（ICC，0.842；95% CI，0.556-0.934）方面，术者之间的一致性良好：结论：在四肢骨折的术后检查中，断层合成术可对骨折线和关节内螺钉定位进行更好的评估，诊断可信度更高，而辐射剂量与传统放射线造影相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Investigative Radiology 医学-核医学

CiteScore

15.10

自引率

16.40%

发文量

188

审稿时长

4-8 weeks

期刊介绍： Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.