1. 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
- Author
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Catherine Cyteval, Solenne J Lanotte, Ahmed Larbi, Bruno Vande Berg, Aymeric Hamard, Charbel Mourad, Nicolas Michoux, M.-P. Baron, Jacques Malghem, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain = Catholic University of Louvain (UCL), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
- Subjects
Male ,MESH: Magnetic Resonance Imaging ,030218 nuclear medicine & medical imaging ,MESH: Aged, 80 and over ,0302 clinical medicine ,Medicine ,Femur ,Prospective Studies ,Fractures, Closed ,Neuroradiology ,MESH: Aged ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,Interventional radiology ,General Medicine ,Magnetic Resonance Imaging ,3. Good health ,MESH: Reproducibility of Results ,MESH: Femur ,Exact test ,[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system ,030220 oncology & carcinogenesis ,Hip fractures ,Female ,Radiology ,MESH: Tomography, X-Ray Computed ,Femoral Fractures ,medicine.medical_specialty ,Population ,MESH: Femoral Fractures ,Sensitivity and Specificity ,03 medical and health sciences ,Computed Tomography ,McNemar's test ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Aged ,MESH: Humans ,business.industry ,MESH: Fractures, Closed ,Reproducibility of Results ,Magnetic resonance imaging ,Occult ,MESH: Sensitivity and Specificity ,MESH: Male ,MESH: Prospective Studies ,Confidence interval ,Elderly patients ,Tomography, X-Ray Computed ,business ,MESH: Female - Abstract
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. 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. 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%], (pR1 = 0.1250), [− 4.5%; + 1.2%] (pR2 = 0.2188), [− 3.4%; + 1.1%] (pR3 = 0.2500) to [− 3.8%; + 1.6%] (pR4 = 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. 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. • 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.
- Published
- 2019
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