Abstract
The aim of this study was to evaluate and compare the diagnostic accuracy, the inter-rater agreement and raters’ certainty of cone beam computed tomography (CBCT) and radiography for the detection of scaphoid fractures. Our hypothesis is that the CBCT has a higher diagnostic accuracy for scaphoid fractures than radiography. We retrospectively analysed patients who underwent both radiography and CBCT examinations within 4 days to rule out a scaphoid fracture over a 2-year period in our institution. 4 blinded radiologists and orthopaedic surgeons independently rated the images regarding the presence of a scaphoid fracture. The reference standard was evaluated by two radiologists in a consensus reading. Inter-rater correlation was evaluated, pooled sensitivity, specificity, positive and negative predictive values were calculated and compared. 102 patients met the inclusion criteria. 52% of them had a scaphoid fracture. The inter-rater correlation was higher in the CBCT compared to radiography (P < 0.001). Sensitivity, specificity, positive and negative predictive values were higher for CBCT than for radiography (P < 0.019). Observers’ fracture classifications showed a higher correlation with the reference standard in the CBCT. Observers’ certainty for fracture detection and classification were higher in the CBCT. CBCT shows a higher diagnostic accuracy for scaphoid fractures than radiography.
Highlights
Diagnostic accuracy of plain radiography for scaphoid fractures is known to be low[1]
1034 potentially eligible participants had undergone cone-beam computed tomography (CBCT) imaging of the wrist in our institution from November 2012 to November 2014. 873 patients were excluded because they had no radiographs taken+/− 4 days of the CBCT examination. 57 patients were excluded because there was no clinical suspicion of scaphoid fracture. 2 patients were excluded because the electronic health record was not complete
We demonstrate that compared to radiography CBCT has a higher sensitivity, specificity, positive and negative predictive value for the detection of scaphoid fractures
Summary
Diagnostic accuracy of plain radiography for scaphoid fractures is known to be low[1]. For the diagnostic accuracy of scaphoid fractures, no significant difference between the sensitivity of radiographs and CBCT could be found in an initial study, which applied MRI as a reference standard[14]. This recent finding is in contrast to our clinical experience. The purpose of our study was to evaluate and compare the diagnostic accuracy of CBCT and radiography for the detection of scaphoid fractures. We investigate the inter-rater correlation of both modalities and the certainty the readers have in the diagnosis made
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