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Purpose <p>To compare intraoperative C-arm cone-beam computed tomography (CBCT) with dedicated in-house-optimized magnetic resonance imaging (MRI) protocols, including CT-like and metal artifact reduction sequences (MARS), using a novel 15-channel coil for the evaluation of fracture reduction, osteosynthesis material positioning, and the depiction of plates and screws.</p> Methods <p>Fifteen patients (13 men, 2 women; median age, 32 years; range, 18–65 years) with acute cranio-maxillofacial fractures underwent surgical treatment with intraoperative CBCT, followed by early postoperative MRI within 36&#xa0;h. MRI protocols included 3D ultrashort echo time (UTE), slice-encoding for metal artifact correction (SEMAC), and 3D double-echo steady-state (DESS). Two independent maxillofacial surgeons performed qualitative and quantitative evaluations of fracture reduction, osteosynthesis material positioning, and implant morphology using a 5-point visual scale (5 = best; 1 = non-assessable) and dimensional measurements. Descriptive statistics were calculated, and inter-reader agreement was assessed using weighted kappa (κ) and intraclass correlation coefficients (ICC).</p> Results <p>UTE and SEMAC sequences provided excellent CT-like performance in visualizing fracture reduction and implant positioning (median 5, IQR 5–5 and 4–5, respectively), with minimal absolute differences in quantitative measurements and substantial to almost perfect inter-reader agreement (κ = 0.75-1.0; ICC = 0.89–0.99; all <i>p</i> &lt; 0.001). In contrast, DESS demonstrated limited utility for assessing metallic implants due to pronounced signal voids and susceptibility artifacts.</p> Conclusion <p>UTE and SEMAC provide high-quality, radiation-free imaging for evaluating fracture reduction and osteosynthesis material in cranio-maxillofacial trauma. These techniques demonstrate comparable diagnostic performance to intraoperative CBCT in a postoperative setting. They may serve as a radiation-free alternative for perioperative imaging in younger patients with anticipated repeated imaging needs, pending prospective intraoperative validation.</p> Trial registration number <p>Swiss National Clinical Trials Portal: SNCTP000006343, ClinicalTrials.gov ID: NCT07012850, Registration date: May 2025.</p>

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Intraoperative C-arm CBCT versus early postoperative MRI for the assessment of fracture reduction and osteosynthesis material positioning in cranio-maxillofacial trauma surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月26日

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  • Adib Al-Haj Husain,
  • Sameena Sandhu,
  • Egon Burian,
  • Marc M. Precht,
  • Stefan Sommer,
  • Thomas Frauenfelder,
  • Maximilian Eberhard Hermann Wagner,
  • Harald Essig

摘要

Purpose

To compare intraoperative C-arm cone-beam computed tomography (CBCT) with dedicated in-house-optimized magnetic resonance imaging (MRI) protocols, including CT-like and metal artifact reduction sequences (MARS), using a novel 15-channel coil for the evaluation of fracture reduction, osteosynthesis material positioning, and the depiction of plates and screws.

Methods

Fifteen patients (13 men, 2 women; median age, 32 years; range, 18–65 years) with acute cranio-maxillofacial fractures underwent surgical treatment with intraoperative CBCT, followed by early postoperative MRI within 36 h. MRI protocols included 3D ultrashort echo time (UTE), slice-encoding for metal artifact correction (SEMAC), and 3D double-echo steady-state (DESS). Two independent maxillofacial surgeons performed qualitative and quantitative evaluations of fracture reduction, osteosynthesis material positioning, and implant morphology using a 5-point visual scale (5 = best; 1 = non-assessable) and dimensional measurements. Descriptive statistics were calculated, and inter-reader agreement was assessed using weighted kappa (κ) and intraclass correlation coefficients (ICC).

Results

UTE and SEMAC sequences provided excellent CT-like performance in visualizing fracture reduction and implant positioning (median 5, IQR 5–5 and 4–5, respectively), with minimal absolute differences in quantitative measurements and substantial to almost perfect inter-reader agreement (κ = 0.75-1.0; ICC = 0.89–0.99; all p < 0.001). In contrast, DESS demonstrated limited utility for assessing metallic implants due to pronounced signal voids and susceptibility artifacts.

Conclusion

UTE and SEMAC provide high-quality, radiation-free imaging for evaluating fracture reduction and osteosynthesis material in cranio-maxillofacial trauma. These techniques demonstrate comparable diagnostic performance to intraoperative CBCT in a postoperative setting. They may serve as a radiation-free alternative for perioperative imaging in younger patients with anticipated repeated imaging needs, pending prospective intraoperative validation.

Trial registration number

Swiss National Clinical Trials Portal: SNCTP000006343, ClinicalTrials.gov ID: NCT07012850, Registration date: May 2025.