BACKGROUND Pediatric elbow fractures are common but remain challenging to accurately diagnose. Digital tomosynthesis is a technique that has shown promise in difficult adult fracture patterns but has not been formally studied in the pediatric population. OBJECTIVE To assess the added value of digital tomosynthesis on the detection and diagnostic confidence of pediatric elbow fractures. MATERIALS AND METHODS A retrospective study was performed between January 2016 and December 2017 in pediatric patients (≤18 years) to assess the ability of conventional elbow radiographs and digital tomosynthesis to detect elbow fractures. One hundred twenty-one pediatric patients with concern for pediatric elbow trauma (64 males, 57 females; mean age: 8.1 years, range: 1 year to 17 years) were imaged with both conventional elbow radiographs and digital tomosynthesis. Two blinded pediatric radiologists identified fractures and indicated their diagnostic confidence. Observer agreement was assessed with Cohen's Kappa coefficient and a nonparametric Wilcoxon rank sum test was used to compare the degree of diagnostic confidence between standard radiographs alone and standard radiographs with digital tomosynthesis. McNemar's test was used to assess the difference in the rate of fracture detection between the two methods and sensitivity, specificity, precision, accuracy and diagnostic odds ratios were calculated. RESULTS Compared with standard radiographs alone, standard radiographs with digital tomosynthesis improved inter-rater agreement, sensitivity, specificity, accuracy, precision and the diagnostic odds ratio for fracture detection and increased diagnostic confidence (Rater 1: P=0.01, Rater 2: P=0.003). CONCLUSION The addition of digital tomosynthesis with conventional elbow radiographs improves diagnostic confidence and performance for the detection of pediatric elbow fractures.

中文翻译：

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通过数字断层合成技术提高小儿肘部骨折的诊断置信度和准确性。

背景技术小儿肘部骨折很常见，但仍然难以准确诊断。数字断层合成技术已在困难的成人骨折模式中显示出希望，但尚未在儿科人群中进行正式研究。目的评估数字断层合成对儿童肘部骨折的诊断和诊断的附加价值。材料与方法回顾性研究于2016年1月至2017年12月对儿童患者（≤18岁）进行评估，以评估常规肘部X光片和数字断层扫描检测肘部骨折的能力。一百一十二例儿科肘关节创伤患儿（男64例，女57例；平均年龄：8.1岁，范围：1到17岁）用常规的肘部X射线摄影和数字断层合成技术成像。两名失明的儿科放射科医生确定了骨折并表明了他们的诊断信心。观察者的一致性通过Cohen的Kappa系数进行评估，并且使用非参数Wilcoxon秩和检验来比较单独的标准X射线照片和具有数字断层合成的标准X射线照片之间的诊断置信度。McNemar检验用于评估两种方法之间的骨折检测率差异，并计算出敏感性，特异性，精密度，准确性和诊断比值比。结果与单独的标准X射线照片相比，具有数字断层合成技术的标准X射线照片改善了评分者之间的一致性，敏感性，特异性，准确性，精确度和骨折检测的诊断比值比和增加的诊断置信度（等级1：P = 0.01，评分器2：P = 0.003）。结论在常规肘部X光片上增加数字断层合成技术可以提高诊断小儿肘部骨折的置信度和性能。