title: Frontobasilar fractures: proposal for image reviewing algorithm.
abstract: OBJECTIVE
  The aim of this study was to develop and test the utility of a novel systematic protocol to analyze CT images of patients with trauma in the anterior cranial base and upper midface.
  
  
  METHODS
  The radiological data and primary reports of 27 consecutive patients with a frontal skull base fracture treated in two tertiary care hospitals from 2007 to 2011 were scrutinized. A novel algorithm for systematic image reviewing was used to assess the CT images and the findings were compared with the primary radiological reports.
  
  
  RESULTS
  The systematic review detected a substantial number of fractures and defects in anatomical structures that had not been systematically reported in the primary, on-call reports. Anterior skull base fracture was not initially reported in 32% of the patients; however, the algorithm detected this in 93% of them. The corresponding rates for fracture through cribriform plate were 28% and 72% and for fracture through the sella or hypophyseal area 22% and 78%. There were two fractures of the clivus and these were initially missed.
  
  
  CONCLUSIONS
  Despite the failure to identify these fractures radiologically in the primary setting, all patients were still considered to have received appropriate treatment, but, the use of an image-reviewing algorithm will enhance the specificity of CT in the diagnosis of frontobasilar fractures.
authors: Department of Otolaryngology - Head and Neck Surgery (Head: Prof. Reidar Grénman), Turku University Hospital and University of Turku, P.O. Box 52, FI-20521 Turku, Finland. Electronic address: ulla.perheentupa@utu.fi.
authors: Ulla
authors: U
authors: Perheentupa
authors: Department of Otolaryngology - Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Finland; School of Science, Department of Industrial Engineering and Management, BIT Research Centre, Aalto University, Finland.
authors: Antti A
authors: AA
authors: Mäkitie
authors: Department of Radiology, Turku University Hospital and University of Turku, Finland.
authors: Jari O
authors: JO
authors: Karhu
authors: Department of Otolaryngology - Head and Neck Surgery, Oulu University Hospital and University of Oulu, Finland.
authors: Petri
authors: P
authors: Koivunen
authors: Department of Radiology, Oulu University Hospital and University of Oulu, Finland.
authors: Roberto
authors: R
authors: Blanco Sequieros
authors: Department of Otolaryngology - Head and Neck Surgery (Head: Prof. Reidar Grénman), Turku University Hospital and University of Turku, P.O. Box 52, FI-20521 Turku, Finland.
authors: Ilpo
authors: I
authors: Kinnunen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005005:Ethmoid Sinus / Q000293:injuries; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D008297:Male; D008440:Maxillary Fractures / Q000000981:diagnostic imaging; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D009295:Nasal Bone / Q000000981:diagnostic imaging / Q000293:injuries; D009917:Orbital Fractures / Q000000981:diagnostic imaging; D020205:Skull Fracture, Basilar / Q000000981:diagnostic imaging*; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000293:injuries; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000293:injuries; D055815:Young Adult
keywords: Algorithm; Computed tomography; Maxillofacial surgery; Trauma