Three-dimensional Computed Tomography Reconstruction Enhances the Diagnostic Reliability of Lisfranc Injury
2Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Purpose:
To evaluate the intra/inter reader and diagnostic reliability of 3-dimensional (3D) model reconstruction computed tomography (CT) compared to the traditional two-dimensional (2D) CT when evaluating for lisfranc (LF) injury.
Methods:
A retrospective population-based study was performed of all CT studies of patients with suspected clinical LF injury examined in emergency department at medium size medical Center between 1/1/202017-31/12/2020. Each CT study was evaluated for metatarsal fractures, dislocation, and the distance between the base of the second metatarsal and medial cuneiform bones employing both 2D and 3D CT model reconstruction.
Four orthopaedics, 2 seniors and 2 residents, were assigned to review and evaluate each CT. Each CT study was reviewed twice by each reader in a randomized order.
Descriptive statistics were calculated for all measured variables. The intra and inter class coefficients (ICC) were calculated to evaluate the reliability and reproducibility between readers for each modality.
Results:
The study included 44 patients. Median age was 33 years (interquartile range, 21-51). Three dimensional CT showed higher metatarsal bones dislocation diagnosis rate compared to 2D CT (64% vs 47%) with higher intra-reader reliability (0.81 vs 0.73, p<0.001). Moderate inter-reader reliability within each modality was observed, with slightly higher ICC value in 2D CT modality (0.69 vs 0.58, p<0.001). In terms of fracture diagnosis, similar rates were observed between 2D and 3D modalities. The inter-reader reliability between methods (2D and 3D) was moderate with ICC of 0.61 (95% CI 0.2-0.8).
Conclusion:
The employment of 3D CT seems to enhance the diagnostic reliability when evaluating for LF injury, specifically in terms of dislocation diagnosis.