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Selected Publication:
Baron, K.
Fracture assessment using MR based methods
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2017. pp. 114
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- Authors Med Uni Graz:
- Advisor:
- Hofer Herwig
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- Abstract:
- To date, the analysis of bone fractures is based on the evaluation of radiographic methods. These methods are predominantly relying on the experience of the radiological expert and include the exposure to ionizing radiation. In contrary, magnetic resonance imaging (MRI) allows for the examination of hard and soft tissue structures without exposure to radiation. However, the application of MRI especially within the context of the assessment of the age of a fracture is a novel approach which has the potential to become especially important in cases of maltreatment, child abuse, insurance litigations and follow-up prosecution. The herein presented work outlines two experimental trials for the identification and evaluation of morphological and quantitative magnetic resonance imaging (qMRI) parameters in order to determine the time span since a bone fracture occurred. First a retrospective data analysis of a previously accomplished preclinical explorative trial was done. Goal of this preclinical study was to simulate a qMRI fracture analysis and to determine whether and to what extent the healing process can be defined by sequential changes when using MRI. Second, an ongoing long term explorative clinical trial involving adult humans was established, in which relevant human specific parameters and additional MR sequences were tested. In the original preclinical trial epiphyseal drill-hole fractures of the tibia were surgically inflicted in 7 Sprague-Dawley rats before scanning them on a 3T scanner (Siemens AG, Erlangen, Germany). Within the clinical trial, fractures of 34 test subjects were scanned on a 3T scanner (Siemens AG, Erlangen, Germany). All sequences allowed the morphological evaluation of fractures as well as the calculation of quantitative maps. These maps were used to analyse the fractures according to the time line of fracture repair. Furthermore, within the clinical trial, a morphological evaluation of the data was performed. By comparison of the error rates of the quantitative and morphological (qualitative) approach, a determination of the accuracy of the quantitative fracture analysis was established. Within both trials changes along the time line of fracture healing were established. Additionally, the radiological examination showed poor agreements with the actual time of fracture occurrence, presenting a clear need for an improved method for fracture analysis. To conclude, all results indicate a high potential for qMRI not only within a clinical context to detect e.g. growth defects or developmental alterations in juvenile bone but also for forensically relevant questions such as the analysis of the fracture and the fractures age in cases of maltreatment, abuse or insurance litigations.