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Randomized Controlled Trial
. 2018 Dec;47(8):20170423.
doi: 10.1259/dmfr.20170423. Epub 2018 May 31.

Diagnostic reliability of low dose multidetector CT and cone beam CT in maxillofacial trauma-an experimental blinded and randomized study

Romke Rozema  1 , Michiel Hj Doff, Peter Ma van Ooijen  2   3 , Douwe Postmus  4 , Henriëtte E Westerlaan  3 , Martijn F Boomsma  5 , Baucke van Minnen  1
Affiliations
Randomized Controlled Trial

Diagnostic reliability of low dose multidetector CT and cone beam CT in maxillofacial trauma-an experimental blinded and randomized study

Romke Rozema et al. Dentomaxillofac Radiol. 2018 Dec.

Abstract

Objectives: To assess the diagnostic reliability of low dose multidetector CT (MDCT) and cone beam CT (CBCT) for zygomaticomaxillary fracture diagnosis.

Methods: Unilateral zygomaticomaxillary fractures were inflicted on four out of six fresh frozen human cadaver head specimens. All specimens were scanned using four MDCT and two CBCT imaging protocols of which the radiation exposure was systematically reduced. A blinded diagnostic routine was simulated at which 16 radiologists and 8 oral and maxillofacial (OMF) surgeons performed randomized image assessments. We considered the findings during an open operative approach of the zygomatic region as the gold standard.

Results: Zygomaticomaxillary fractures were correctly diagnosed in 90.3% (n = 130) of the image assessments. The zygomatic arch was most often correctly diagnosed (91.0%). The zygomatic alveolar crest showed the lowest degree of correct diagnosis (65.3%). Dose reduction did not significantly affect the objective visualization of fractures of the zygomaticomaxillary complex. The sensitivity and specificity also remained consistent among the low dose scan protocols. Dose reduction did not decrease the ability to assess dislocation, comminution, orbital volume, volume rendering and soft tissues. OMF surgeons considered the low dose protocols sufficient for treatment planning.

Conclusions: Dose reduction did not decrease the diagnostic reliability of MDCT and CBCT for the diagnosis of zygomaticomaxillary fractures.

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Figures

Figure 1.
Figure 1.
Impact model used to inflict unilateral zygomaticomaxillary fractures.
Figure 2.
Figure 2.
A right-sided zygomaticomaxillary fracture in the zygomatic arch, the anterior and posterior sinus maxillary wall. The MD CT quality reference mAs 50 and 20 (A,C) scan protocols and the CBCT baseline and ultra-low dose (B,D) scan protocols are compared consecutively. CBCT, cone beam CT; MDCT, multidetector CT; ULD, ultra-low dose.
Figure 3.
Figure 3.
Approach used as gold standard. For this specimen the 3D volume rendering (A, C) is compared to the surgical approach (B, D) from the same projection. Fractures were recorded in the zygomatic arch, frontozygomatic suture, infra-orbital rim, anterior maxillary sinus wall and lateral orbital wall. 3D volume, three-dimensional volume.
See this image and copyright information in PMC

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