Combining gantry-free cone-beam computed tomography with iterative metal artefact reduction for surgical follow-up imaging of the appendicular skeleton. Issue 155 (October 2022)

• Record Type: Journal Article
• Authors: Patzer, Theresa Sophie; Grunz, Jan-Peter; Huflage, Henner; Conrads, Nora; Veldhoen, Simon; Schmalzl, Jonas; Pennig, Lenhard; Bley, Thorsten Alexander; Luetkens, Karsten Sebastian; Kunz, Andreas Steven
• Is Part Of: European journal of radiology. Issue 155(2022)
• Publication Date: 2022-10
• Subjects: Cone-beam computed tomography -- Radiography -- Metal artefacts -- Osteoplasty -- Postoperative imaging; CBCT cone-beam computed tomography -- IQR interquartile range -- MAR metal artefact reduction -- MDCT multidetector computed tomography; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110465
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: CBCT allows for reliable diagnosis of osteoplasty-related complications. Diagnostic accuracy of CBCT superseded radiography considerably. Due to lower dose, radiography remains the primary postsurgical imaging method. Abstract: Purpose: Post-surgical evaluation of osteosynthesis material and adjacent tissue can be challenging in both radiography and cross-sectional imaging. This study investigates the performance of a multi-purpose X-ray scanner with cone-beam CT (CBCT) function and iterative metal artefact reduction capabilities in patients after osteoplasty of the appendicular skeleton. Method: Eighty individuals who underwent both conventional X-ray imaging and CBCT after osteoplasty of the hand/wrist (48), elbow (14), or ankle/foot (18) with the gantry-free twin robotic system were retrospectively enrolled. Radiological reports from clinical routine for both imaging modalities were retrospectively analyzed and compared with consensus expert reading by two musculoskeletal specialists serving as the standard of reference. Findings of screw dislocation or implant loosening, fragment displacement, and delayed healing were compared between X-ray and CBCT reports using the McNemar test. Results: The median dose-area-product of CBCT and X-ray scans amounted to 27.98 and 0.2 dGy*cm 2, respectively. Diagnostic accuracy for screw dislocation was superior in CBCT compared to standard radiograms (98.8 % vs 83.8 %; p = 0.002). Implant loosening (98.8 % vs 86.3 %; p = 0.006), fragment displacement (98.8 % vs 85.0 %; p < 0.001), and delayed healing (97.5 % vs 88.8 %; p = 0.016) were also more reliably detected in CBCT. Employing CBCT, postoperative complications were detected with a sensitivity and specificity of at least 95.8 % and 98.1 %, compared to 33.3 % and 92.86 % in radiography. Conclusions: With superior accuracy for various osteoplasty-related complications, the CBCT scan mode of a gantry-free twin robotic X-ray system with iterative metal artefact reduction aids post-surgical assessment in the appendicular skeleton.