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01-02-2020 | Femoral Fracture | Emergency Radiology

Value of CT to detect radiographically occult injuries of the proximal femur in elderly patients after low-energy trauma: determination of non-inferiority margins of CT in comparison with MRI

Authors: Solenne J. Lanotte, Ahmed Larbi, Nicolas Michoux, Marie-Pierre Baron, Aymeric Hamard, Charbel Mourad, Jacques Malghem, Catherine Cyteval, Bruno C. Vande Berg

Published in: European Radiology | Issue 2/2020

Abstract

Purpose

To determine the margins of non-inferiority of the sensitivity of CT and the sample size needed to test the non-inferiority of CT in comparison with MRI.

Materials and methods

During a 2-year period, elderly patients with suspected radiographically occult post-traumatic bone injuries were investigated by CT and MRI in two institutions. Four radiologists analyzed separately the CT and MRI examinations to detect post-traumatic femoral injuries. Their sensitivities at CT (SeCT) and MRI (SeMRI) were calculated with the reference being a best valuable comparator (consensus reading of the MRI and clinical follow-up). ROC analysis followed by an exact test (Newcombe’s approach) was performed to assess the 95% confidence interval (CI) for the difference SeCT–SeMRI for each reader. A sample size calculation was performed based on our observed results by using a one-sided McNemar’s test.

Results

Twenty-nine out of 102 study participants had a post-traumatic femoral injury. SeCT ranged between 83 and 93% and SeMRI ranged between 97 and 100%. The 95% CIs for (SeCT–SeMRI) were [− 5.3%, + 0.8%], (p^R1 = 0.1250), [− 4.5%; + 1.2%] (p^R2 = 0.2188), [− 3.4%; + 1.1%] (p^R3 = 0.2500) to [− 3.8%; + 1.6%] (p^R4 = 0.3750) according to readers, with a lowest limit for 95% CIs superior to a non-inferiority margin of (− 6%) for all readers. A population of 440 patients should be analyzed to test the non-inferiority of CT in comparison with MRI.

Conclusion

CT and MRI are sensitive for the detection of radiographically occult femoral fractures in elderly patients after low-energy trauma. The choice between both these modalities is a compromise between the most available and the most sensitive technique.

Key Points

• The sensitivity of four separate readers to detect radiographically occult post-traumatic femoral injuries in elderly patients after low-energy trauma ranged between 83 and 93% at CT and between 97 and 100% at MRI according to a best valuable comparator including MRI and clinical follow-up.

• CT is a valuable alternative method to MRI for the detection of post-traumatic femoral injuries in elderlies after low-energy trauma if a 6% loss in sensitivity can be accepted in comparison with MRI.

• The choice between CT and MRI is a compromise between the most available and the most sensitive technique.

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Title: Value of CT to detect radiographically occult injuries of the proximal femur in elderly patients after low-energy trauma: determination of non-inferiority margins of CT in comparison with MRI
Authors: Solenne J. Lanotte
Ahmed Larbi
Nicolas Michoux
Marie-Pierre Baron
Aymeric Hamard
Charbel Mourad
Jacques Malghem
Catherine Cyteval
Bruno C. Vande Berg
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Femoral Fracture
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Computed Tomography
Published in: European Radiology / Issue 2/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06387-2

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Springer Medicine

Value of CT to detect radiographically occult injuries of the proximal femur in elderly patients after low-energy trauma: determination of non-inferiority margins of CT in comparison with MRI

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

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