Diagnostic accuracy of ultra-low-dose CT compared to standard-dose CT for identification of non-displaced fractures of the shoulder, knee, ankle, and wrist

OBJECTIVES: To compare the performance of ultra-low-dose computed tomography (ULD-CT) with standard-dose computed tomography (SD-CT) for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist. METHODS: This prospective study enrolled 92 patients receiving conservative treatment for limb joint fractures who underwent SD-CT followed by ULD-CT at a mean interval of 8.85 ± 1.98 days. Fractures were characterized as displaced or non-displaced. Objective (signal-to-noise ratio, contrast-to-noise ratio) and subjective CT image quality were evaluated. Observer performance for ULD-CT and SD-CT detecting non-displaced fractures was estimated by calculating the area under the receiver operating characteristic (ROC) curve (A(z)). RESULTS: The effective dose (ED) for the ULD-CT protocol was significantly lower than the ED for the SD-CT protocol (F = 422.21~2112.25, p < 0.0001); 56 patients (65 fractured bones) had displaced fractures, and 36 patients (43 fractured bones) had non-displaced fractures. Two non-displaced fractures were missed by SD-CT. Four non-displaced fractures were missed by ULD-CT. Objective and subjective CT image quality was significantly improved for SD-CT compared to ULD-CT. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of SD-CT and ULD-CT for non-displaced fractures of the shoulder, knee, ankle and wrist were similar: 95.35% and 90.70%; 100% and 100%; 100% and 100%; 99.72% and 99.44%; and 99.74% and 99.47%, respectively. The A(z) was 0.98 for SD-CT and 0.95 for ULD-CT (p = 0.32). CONCLUSION: ULD-CT has utility for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist and can support clinical decision-making.