title: Illusions of fusions: assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs.
abstract: BACKGROUND
  The aims of this study were to compare lateral cephalograms with other radiologic methods for diagnosing suspected fusions of the cervical spine and to validate the assessment of congenital fusions and osteoarthritic changes against the anatomic truth.
  
  
  METHODS
  Four cadaver heads were selected with fusion of vertebrae C2 and C3 seen on a lateral cephalogram. Multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) were performed and assessed by 5 general radiologists and 5 oral radiologists, respectively. Vertebrae C2 and C3 were examined for osseous fusions, and the left and right facet joints were diagnosed for osteoarthritis. Subsequently, the C2 and C3 were macerated and appraised by a pathologist. Descriptive analysis was performed, and interrater agreements between and within the groups were computed.
  
  
  RESULTS
  All macerated specimens showed osteoarthritic findings of varying degrees, but no congenital bony fusion. All observers agreed that no fusion was found on MDCT or CBCT. They disagreed on the prevalence of osteoarthritic deformities (general radiologists/MDCT, 100%; oral radiologists/CBCT, 93.3%) and joint space assessment in the facet joints (kappa = 0.452). The agreement within the rater groups differed considerably (general radiologists/MDCT, kappa = 0.612; oral radiologists/CBCT, kappa = 0.240).
  
  
  CONCLUSIONS
  Lateral cephalograms do not provide dependable data to assess the cervical spine for fusions and cause false-positive detections. Both MDCT interpreted by general radiologists and CBCT interpreted by oral radiologists are reliable methods to exclude potential fusions. Degenerative osteoarthritic changes are diagnosed more accurately and consistently by general radiologists evaluating MDCT.
authors: Clinic for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland. raphael.patcas@zzm.uzh.ch
authors: Raphael
authors: R
authors: Patcas
authors: Dominika
authors: D
authors: Tausch
authors: Nikolaos
authors: N
authors: Pandis
authors: Mirjana
authors: M
authors: Manestar
authors: Oliver
authors: O
authors: Ullrich
authors: Christoph A
authors: CA
authors: Karlo
authors: Timo
authors: T
authors: Peltomäki
authors: Christian J
authors: CJ
authors: Kellenberger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002508:Cephalometry; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D054893:Cone-Beam Computed Tomography; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D010003:Osteoarthritis / Q000175:diagnosis / Q000000981:diagnostic imaging; D013122:Spinal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D021801:Zygapophyseal Joint / Q000473:pathology