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. 2021 Apr;31(4):2621-2633.
doi: 10.1007/s00330-020-07304-8. Epub 2020 Oct 9.

Ultra-low-dose CT versus radiographs for minor spine and pelvis trauma: a Bayesian analysis of accuracy

Aymeric Hamard  1 , Joel Greffier  2 , Sophie Bastide  3 , Ahmed Larbi  2 , Takieddine Addala  2 , Alexandre Sadate  2 , Jean-Paul Beregi  2 , Julien Frandon  2
Affiliations

Ultra-low-dose CT versus radiographs for minor spine and pelvis trauma: a Bayesian analysis of accuracy

Aymeric Hamard et al. Eur Radiol. 2021 Apr.

Abstract

Objectives: To compare diagnosis performance and effective dose of ultra-low-dose CT (ULD CT) versus radiographs in suspected spinal or pelvic ring or hip fracture for minor trauma.

Methods: ULD CT, in addition to radiography, was prospectively performed in consecutive patients admitted to the emergency department for minor traumas, during working hours over 2 months. Presence of a recent fracture was assessed by two blind radiologists independently. Sensitivities and specificities were estimated using the best valuable comparator (BVC) as a reference and using a latent class model in Bayesian inference (BLCM). Dosimetric indicators were recorded and effective doses (E) were calculated using conversion coefficient.

Results: Eighty areas were analyzed in 69 patients, including 22 dorsal spine, 28 lumbar spine, and 30 pelvic ring/hip. Thirty-six fractures (45%) were observed. Applying the BVC method, depending on location, ULD CT sensitivity was 80 to 100% for reader 1 and 85 to 100% for reader 2, whereas radiographic sensitivity was 60 to 85% for reader 1 and 50 to 92% for reader 2. With BLCM approach for reader 2, ULD CT sensitivity for all locations/dorsal spine/lumbar spine and pelvic ring-hip was 87.1/75.9/84.2/76.9% respectively. Corresponding radiograph sensitivity was 73.8, 54.8, 80.4, and 68.7%. Effective doses of ULD CT were similar to radiographs for dorsal and hip locations whereas for lumbar spine, ULD CT effective dose was 1.83 ± 0.59 mSv compared with 0.96 ± 0.59 mSv (p < 0.001).

Conclusion: Sensitivity for fracture detection was higher for ULD CT compared with radiographs with an effective dose comparable to radiographs.

Key points: • Ultra-low-dose spine and pelvis CT demonstrates better fracture detection when compared with radiographs. • The effective dose of ultra-low-dose spine and pelvis CT scan and radiographs is comparable. • Replacement of radiographs by ULD CT in daily practice for trauma patients is an option to consider and should be evaluated by a randomized trial.

Keywords: Emergency service; Hip fractures; Latent class analysis; Lumbar vertebrae; Radiography; Running head: latent class analysis.

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References

    1. HAS, SOFCOT, SFGG (2017) Haute Autorité de Santé - Orthogériatrie et fracture de la hanche.
    1. Looby S, Flanders A (2011) Spine Trauma. Radiol Clin North Am 49:129–163 - PubMed - DOI
    1. Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21:492–499 - DOI
    1. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 7:221–227 - PubMed - DOI
    1. Heinemann U, Freund M (2006) Diagnostic strategies in spinal trauma. Eur J Radiol 58:76–88 - PubMed - DOI