Brain Computed Tomography Compared with Facial 3-Dimensional Computed Tomography for Diagnosis of Facial Fractures

Objectives To compare the detection of facial fractures and radiation dose between brain computed tomography (CT) and facial 3-dimensional (3D) CT in pediatric patients who have experienced a trauma. Study design Four hundred pediatric patients who experienced a trauma and underwent immediate brain CT and facial 3D CT between January 2016 and June 2016 were included in this retrospective study. Two reviewers independently analyzed and determined the presence of the facial fractures of 8 anatomic regions based on brain CT and facial 3D CT over a 1-week interval. Suggested treatment decisions for facial fractures seen on brain CT and facial 3D CT were evaluated by one physician. The facial 3D CT scans, interpreted by a senior radiologist, were considered as the reference standard. Diagnostic performance, radiation dose, and interobserver agreement of the CT scans were evaluated. Results Brain CT showed a high sensitivity (94.1%-96.5%), high specificity (99.7%-100%), and high accuracy (98.8%-99.0%) in both reviewers, and performed as well as did facial 3D CT (P≥.25). The suggested treatment decision was not different between the brain CT and facial 3D CT findings. The agreements between the reference standard and the reviewers, and between reviewers 1 and 2 were excellent (k=0.946-0.993). The mean effective radiation doses used in brain CT (3.6mSv) were significantly lower than those in brain CT with facial 3D CT (5.5mSv) (P<.001). Conclusions Brain CT showed acceptable diagnostic performance and can be used as the first-line imaging tool in the workup of pediatric patients with suspected facial fractures.