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CT scans remain gold standard compared to plain radiographs for diagnosing subtalar degeneration
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NATIONAL HARBOR, Md. — Using CT scans for assessing degenerative changes in the subtalar joint should remain the gold standard for this pathology, according to an investigation by researchers in the United Kingdom.
“In our study we found that the diagnostic information provided by the gold standard CT scans could not be met with plain X-rays even when using a proper reporting protocol,” Miriam Day, MRCS, said to the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle society, here.
“CT scans are the gold standard, plain X-rays are difficult to interpret and are unreliable and it causes us to question whether there is a place for plain X-rays when investigating the subtalar joint,” Day of Morriston Hospital in Cardiff, U.K., said.
Day said she and her team undertook the comparison of the imaging methods after their radiology colleagues reported an increase in the amount of elective CT scans and wanted to know if they could justify that increase.
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“The subtalar joint is known to be notoriously difficult to assess using plain X-rays and we have seen an increase in CT scanning,” she said.
To compare the systems, the investigators designed an atlas and reporting system for the subtalar joint using a modification of the Kellgren and Lawrence system, according to the study abstract. Orthopaedic surgeons where then asked to report on 50 matched CT scans and plain X-rays and to comment on the status of the anterior, middle and posterior facets.
The endpoint of the study was to prepare a protocol for the use of plain X-rays and CT scans and to see if the gold standards of the CT scans could be met with the plain radiographs, she said.
In 33% of the cases the facets in the plain X-rays could not be appreciated, Day reported. “There was some correlation between the CT scan and plain X-ray reporting in the posterior facets, but in the anterior of middle facets there was no correlation at all.”
Reference:Day M, Topliss, CJ. Radiological diagnosis of degenerative change of the subtalar joint: A study comparing the reported degree of osteoarthritis in a plain radiograph when compared with a CT scan. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 8-10, 2010. National Harbor, Md.