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Skeletal Radiology

19-03-2024 | Rib Fracture | Scientific Article

Performance of thoracic ultrasonography compared with chest radiography for the detection of rib fractures using computed tomography as a reference standard

Authors: Evangelia E. Vassalou, Iraklis Perysinakis, Michail E. Klontzas, Eelco de Bree, Apostolos H. Karantanas

Published in: Skeletal Radiology

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Abstract

Objective

Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures’ detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard.

Materials and methods

Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann–Whitney U test and Fisher’s exact test.

Results

Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures’ detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P < .001) in detecting individual rib fractures. Most fractures involved the 4th–9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries.

Conclusion

Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT.
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Metadata
Title
Performance of thoracic ultrasonography compared with chest radiography for the detection of rib fractures using computed tomography as a reference standard
Authors
Evangelia E. Vassalou
Iraklis Perysinakis
Michail E. Klontzas
Eelco de Bree
Apostolos H. Karantanas
Publication date
19-03-2024
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-024-04658-8