TY  - JOUR
A1  - Patzer, Theresa Sophie
A1  - Kunz, Andreas Steven
A1  - Huflage, Henner
A1  - Conrads, Nora
A1  - Luetkens, Karsten Sebastian
A1  - Pannenbecker, Pauline
A1  - Paul, Mila Marie
A1  - Ergün, Süleyman
A1  - Bley, Thorsten Alexander
A1  - Grunz, Jan-Peter
T1  - Ultrahigh-resolution photon-counting CT in cadaveric fracture models: spatial frequency is not everything
JF  - Diagnostics
N2  - In this study, the impact of reconstruction sharpness on the visualization of the appendicular skeleton in ultrahigh-resolution (UHR) photon-counting detector (PCD) CT was investigated. Sixteen cadaveric extremities (eight fractured) were examined with a standardized 120 kVp scan protocol (CTDI\(_{vol}\) 10 mGy). Images were reconstructed with the sharpest non-UHR kernel (Br76) and all available UHR kernels (Br80 to Br96). Seven radiologists evaluated image quality and fracture assessability. Interrater agreement was assessed with the intraclass correlation coefficient. For quantitative comparisons, signal-to-noise-ratios (SNRs) were calculated. Subjective image quality was best for Br84 (median 1, interquartile range 1–3; p ≤ 0.003). Regarding fracture assessability, no significant difference was ascertained between Br76, Br80 and Br84 (p > 0.999), with inferior ratings for all sharper kernels (p < 0.001). Interrater agreement for image quality (0.795, 0.732–0.848; p < 0.001) and fracture assessability (0.880; 0.842–0.911; p < 0.001) was good. SNR was highest for Br76 (3.4, 3.0–3.9) with no significant difference to Br80 and Br84 (p > 0.999). Br76 and Br80 produced higher SNRs than all kernels sharper than Br84 (p ≤ 0.026). In conclusion, PCD-CT reconstructions with a moderate UHR kernel offer superior image quality for visualizing the appendicular skeleton. Fracture assessability benefits from sharp non-UHR and moderate UHR kernels, while ultra-sharp reconstructions incur augmented image noise.
KW  - photon-counting
KW  - tomography
KW  - X-ray computed
KW  - fracture
KW  - cancellous bone
KW  - convolution kernel
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319281
SN  - 2075-4418
VL  - 13
IS  - 10
ER  - 
TY  - JOUR
A1  - Huflage, Henner
A1  - Fieber, Tabea
A1  - Färber, Christian
A1  - Knarr, Jonas
A1  - Veldhoen, Simon
A1  - Jordan, Martin C.
A1  - Gilbert, Fabian
A1  - Bley, Thorsten Alexander
A1  - Meffert, Rainer H.
A1  - Grunz, Jan-Peter
A1  - Schmalzl, Jonas
T1  - Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns
JF  - BMC Musculoskeletal Disorders
N2  - Background
Morphology and glenoid involvement determine the necessity of surgical management in scapula fractures. While being present in only a small share of patients with shoulder trauma, numerous classification systems have been in use over the years for categorization of scapula fractures. The purpose of this study was to evaluate the established AO/OTA classification in comparison to the classification system of Euler and Rüedi (ER) with regard to interobserver reliability and confidence in clinical practice.
Methods
Based on CT imaging, 149 patients with scapula fractures were retrospectively categorized by two trauma surgeons and two radiologists using the classification systems of ER and AO/OTA. To measure the interrater reliability, Fleiss kappa (κ) was calculated independently for both fracture classifications. Rater confidence was stated subjectively on a five-point scale and compared with Wilcoxon signed rank tests. Additionally, we computed the intraclass correlation coefficient (ICC) based on absolute agreement in a two-way random effects model to assess the diagnostic confidence agreement between observers.
Results
In scapula fractures involving the glenoid fossa, interrater reliability was substantial (κ = 0.722; 95% confidence interval [CI] 0.676–0.769) for the AO/OTA classification in contrast to moderate agreement (κ = 0.579; 95% CI 0.525–0.634) for the ER classification system. Diagnostic confidence for intra-articular fracture patterns was superior using the AO/OTA classification compared to ER (p < 0.001) with higher confidence agreement (ICC: 0.882 versus 0.831). For extra-articular fractures, ER (κ = 0.817; 95% CI 0.771–0.863) provided better interrater reliability compared to AO/OTA (κ = 0.734; 95% CI 0.692–0.776) with higher diagnostic confidence (p < 0.001) and superior agreement between confidence ratings (ICC: 0.881 versus 0.912).
Conclusions
The AO/OTA classification is most suitable to categorize intra-articular scapula fractures with glenoid involvement, whereas the classification system of Euler and Rüedi appears to be superior in extra-articular injury patterns with fractures involving only the scapula body, spine, acromion and coracoid process.
KW  - confidence
KW  - scapula
KW  - glenoid
KW  - fracture
KW  - classification
KW  - reliability
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299795
VL  - 23
IS  - 1
ER  -