Type:
Educational Exhibit
Keywords:
Musculoskeletal bone, Cone beam CT, Equipment, Trauma
Authors:
R. Trueba; Buenos Aires/AR
DOI:
10.26044/ecr2019/C-0096
Findings and procedure details
The CBCT images show greater sensitivity in the detection of bone trauma than conventional radiology (CR) and can visualize small hidden fractures or confirm doubtful fractures.
In most cases,
this has a very important benefit for the early treatment of injuries.
For example,
a high clinical suspicion of carpal fractures,
especially scaphoid bone,
but with a negative radiograph,
a resonance is often recommended to exclude undisplaced occult fractures or bone marrow contusion.
However,
it is not always possible to perform an MRI,
due to possible contraindications or less accessibility.
Therefore,
CBCT can be considered as a second line image modality (Fig.
1,
2).
To monitor bone consolidation and callus formation,
CR can be difficult to assess,
especially in the presence of overlapping splints or plasters (Fig.
3,4).
The CBCT can provide more detailed information on bone architecture compared to CR,
it can also help in the evaluation of the healing process,
which can be more or less underestimated in CR (Fig.
5).
As it is a volumetric acquisition technique with the possibility of multidirectional and three-dimensional reconstructions,
the CBCT is superior to CR in the evaluation of the formation of bone bridges or the presence of lines of residual fractures (Fig.
6,7).
In case of postoperative follow-up after the placement of metallic hardware,
CBCT can facilitate the diagnosis of non-union,
incomplete or total healing (Fig.8-14),
as well as the early detection of loosening or rupture of the hardware (Fig.15-17).
Despite the use of current metal artifact reduction (MARS) sequences,
the general utility of MRI after screw fixation is limited due to metal artifacts.