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1 Department of Radiology, Division of Surgery, University of Vienna Medical
School, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna,
Austria.
2 Department of Radiology, Harborview Medical Center, 325 9th Ave., Box 359728,
Seattle, WA 98104.
3 Department of Radiology, Division of Osteology, University of Vienna Medical
School, General Hospital Vienna, 1090 Vienna, Austria.
OBJECTIVE. Our aim was to optimize acquisition protocols and multiplanar reformation algorithms for the evaluation of facial fractures using multidetector CT (MDCT) and to determine whether 2 x 0.5 mm collimation is necessary.
MATERIALS AND METHODS. A cadaveric head with artificial blunt facial trauma was examined using a four-channel MDCT scanner. The influence of acquisition parameters (collimation, 2 x 0.5 mm, 4 x 1 mm, 4 x 2.5 mm; tube current, 120 mAs, 90 mAs, 60 mAs), image reconstruction algorithms (standard vs ultra-high-resolution modes; reconstructed slice thicknesses, 0.5 mm, 1 mm, 3 mm; increment, 0.3 mm, 0.6 mm, 1.5 mm), and reformation algorithms (slice thicknesses, 0.5 mm, 1 mm, 3 mm; overlap, 0.5 mm, 1 mm, 3 mm) on detectability of facial fractures in multiplanar reformations with MDCT was analyzed.
RESULTS. Fracture detection was significantly higher with thin
multiplanar reformations (0.5 and 0.5 mm, 1 and 0.5 mm, and 1 and 1 mm)
(p 
0.014) acquired with 2 x 0.5 mm collimation (p
0.046) in ultra-high-resolution mode (p < 0.0005) with 120
mAs (p 0.025). Interobserver variability showed very good
agreement (
0.942). Non–ultra-high-resolution mode, lower
milliampere-seconds, and thick multiplanar reformations (3 and 0.5 mm, 3 and 1
mm, and 3 and 0.5 mm) showed significantly decreased fracture
detectability.
CONCLUSION. Although thin multiplanar reformations obtained from thin collimation (2 x 0.5 mm) are statistically superior for the detection of subtle fractures, 4 x 1 mm collimation is sufficient for routine diagnostic evaluation. Ultra-high-resolution mode with 120 mAs is mandatory for detection of clinically relevant fractures.
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