3D-CT in the Diagnosis of Craniofacial and Spine Fractures

Kim, Bum Tae; Shin, Won Han; Choi, Soon Kwan; Byun, Bark Jang

Abstract

Three-dimensional computerized tomography(3DCT) disclosed a valuable tool for the diagnosis of fracture/dislocation involving craniofacial and spinal bony and/or ligamentous structure. We compared the diagnostic accuracy between these non-invasive radiologic diagnostic techniques ; 3DCT, conventional 2DCT and plain X-ray films in patients with traumatic craniofacial or spine fracture. And the other purpose of this study is to define the role of 3DCT in the planning of surgical management. From Jan. 1991 to Jun. 1994, 31 patients with traumatic craniofacial or spine fracture have been studied 3DCT at Soonchunhyang University Hospital. The majority of the patients were male and 3rd decades in ages. 16 cases were operated according to clinical and radiological findings. In 15 cases with craniofacial fracture, 3DCT showed the extent, displacement, angulation, depression and separation of fracture better than plain X-ray or 2DCT. But in one case with frontal basal fracture, 3DCT imaging did not differentiate between skull defect and normal thinning bone. In 16 cases of spine fractures, 3DCT was better diagnostic than 2DCT, paticularlly with subtle lesions. But in 3 cases had bony fragment in spinal canal and one case with pedicle fracture of cervical spine, 2DCT was better accurate than 3DCT. Following conclusions are offered : 3DCT warrants 1) precise, easy looking of direction, extension and shape of fractures, 2) complete perspectives of fracture site in all direction, 3) accurate operative planning with reduced operation time and postoperative complications and 4) amenable to choose instrumentation type and direction of operative approach in spinal surgery. However 3DCT has some disadvantages, 1) It makes difficult to differentiate between normal thin skull basal portion and traumatic skull defect. 2) 3DCT gives an information to only surface cortical bone. 3) It takes additional time and cost for getting complete imaging films.