title: A retrospective, semi-quantitative image quality analysis of cone beam computed tomography (CBCT) and MSCT in the diagnosis of distal radius fractures.
abstract: OBJECTIVE
  To compare image quality and diagnostic validity of CBCT and MSCT for distal radius fractures.
  
  
  METHODS
  35 CBCT and 33 MSCT scans were retrospectively reviewed with a visual grading scale regarding the depiction of cortical bone, trabecular bone, articular surfaces, and soft tissue. The extent and type of artefacts was analyzed. Agreement on AO classification and measurement of cortical disruption and length of the fracture gap was determined. Fracture reduction was evaluated in post-treatment x-rays. Statistical analysis was performed with visual grading characteristics (VGC), chi square tests, and Kendall's coefficient of concordance.
  
  
  RESULTS
  CBCT performed significantly worse for cortical bone, articular surfaces, and especially soft tissue. Trabecular bone showed no significant difference. Significantly more CBCT images showed artefacts. Physics-based artefacts were the most common. CBCT scans also showed motion artefacts. There was no significant difference in agreement on AO classification. The agreement on measurements was substantial for both modalities. Slightly more fractures that had undergone MSCT imaging showed adequate reduction.
  
  
  CONCLUSIONS
  This initial study of an orthopaedic extremity CBCT scanner showed that the image quality of a CBCT scanner remains inferior for most structures at standard settings. Diagnostic validity of both modalities for distal radius fractures seems similar.
  
  
  CONCLUSIONS
  • Subjectively, CBCT remains inferior to MSCT in depicting most structures. • Similar diagnostic validity for CBCT and MSCT imaging of distal radius fractures. • CBCT is a possible alternative to MSCT in musculoskeletal imaging. • Visual grading characteristics (VGC) analysis proves useful in analyzing visual grading scales.
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. jakob.neubauer@uniklinik-freiburg.de.
authors.forename: J
authors.initials: J
authors.lastname: Neubauer
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Fritz
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: E M
authors.initials: EM
authors.lastname: Spira
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Strube
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Kotter
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D000071556:Cancellous Bone / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography / Q000379:methods* / Q000592:standards; D006801:Humans; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods* / Q000592:standards; D011885:Radius Fractures / Q000145:classification / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Cone beam computed tomography; Multislice computed tomography; Musculoskeletal system; Orthopaedics; Radius fracture