Axial or coronal CT scan; which is more accurate in detection of open globe injury?

To evaluate and compare the accuracy of axial versus coronal computerized tomography (CT) scan in detection of open globe injury.

In this retrospective study, records of 61 patients with open and 72 patients with closed globe injury were reviewed. One experienced ophthalmologist and one neuroradiologist read the orbital CT scans and accuracy of the axial and coronal planes in detecting open globe injuries were compared. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and compared for axial and coronal planes.

The most common CT finding reported by the readers through the interpretation chart was scleral irregularity (70%), followed by dislocation of the crystalline lens (54%) and vitreous hemorrhage (51%). The sensitivity of axial, coronal and combined CT planes were 74%, 65%, and 79%, respectively. There was no significant difference between axial and coronal CT scans for detecting open globe injuries (P value=0.075), independent of the type and the location of the globe injury. For posterior injuries and sharp trauma, the sensitivity of coronal plane in detecting open globe injury was significantly lower, compared to axial and combined readings (P value=0.012 and 0.015, respectively). There was a near perfect agreement between readers for all CT scan readings with a Kappa value of 0.9.

Axial CT reading may be as adequate as a multiplanar reading in detection of open globe injury in emergency setting, where timely diagnosis matters. Without clinical and surgical findings, CT cannot provide adequate accuracy for detecting open globe injuries.