Interreader Variability of Computed Tomography for Orbital Floor Fracture

Area of Science:

• Ophthalmology
• Radiology
• Trauma Surgery

Background:

• Orbital floor fracture repair timing and indications are debated.
• Current practice often relies on computed tomography (CT) measurements, specifically >50% orbital floor involvement, to guide surgical intervention.
• Accurate fracture assessment is crucial to prevent long-term sequelae like enophthalmos and diplopia.

Purpose of the Study:

• To evaluate the reliability and variability of CT measurements in assessing orbital floor fractures.
• To determine the concordance among radiologists when measuring orbital floor fracture dimensions.

Main Methods:

• Retrospective analysis of CT scans from 23 patients with isolated orbital floor fractures.
• Three blinded neuroradiologists independently measured anterior-posterior length and transverse width of the fractures.
• Intraclass correlation coefficients (ICCs) were calculated to assess inter-reader agreement.

Main Results:

• Inter-reader agreement for anterior-posterior length was moderate (ICC = 0.66).
• Inter-reader agreement for transverse width was lower, indicating only moderate concordance (ICC = 0.44).
• These findings highlight significant variability in CT measurements even among experienced radiologists.

Conclusions:

• The study questions the sole reliance on CT measurements (e.g., >50% floor involvement) for surgical decision-making in orbital floor fractures.
• Radiological interpretations of fracture size can be highly variable.
• Clinical findings should be prioritized over radiological measurements when determining the need for surgical repair of orbital floor fractures.