Computed tomography scan evaluation of Globe rupture using a novel mnemonic : a single center experience

Globe rupture presents a diagnostic challenge because of potentially vision-threatening outcomes. Although computed tomography (CT) is critical for assessment, a structured interpretation approach is often lacking. This study introduces the novel "FLAP CONE" mnemonic to assist radiologists in evaluating globe rupture.

This was a retrospective study of 143 patients (151 eyes) with suspected globe rupture between January 2015 and December 2020. The male-to-female ratio was 3:1, with a median age of 22 years. Demographics and mechanisms of injury were recorded. CT scans were independently reviewed by two radiologists using the FLAP CONE mnemonic, encompassing Fractures/Foreign bodies, scleral Lacerations/Lens abnormalities, Anterior chamber changes, Posterior segment abnormalities, eye Contour distortion, Orbital apex hematoma, Neurovascular bundle abnormalities, and Extraocular muscles (EOM)/Emphysema. Findings were documented as binary variables. The diagnostic accuracy, sensitivity, specificity, and interobserver agreement (κ) were calculated.

Sharp objects (39%) and falls (25%) were the leading causes of penetrating and blunt trauma, respectively. Use of the mnemonic achieved 91.9% diagnostic accuracy, with 88.3% sensitivity and 98.5% specificity. Orbital emphysema (43%) was the most frequent finding. Postseptal foreign body and the "flat tire" sign were associated with the highest diagnostic performance (sensitivity of 100% and 97.2%, respectively; specificity, 100%; and PPV, 100%). Kappa values ranged from 0.15 (orbital apex hematoma) to 1.0 (postseptal foreign body), with an overall κ = 0.85. Four clinically confirmed ruptures were missed because of subtle scleral defects and the presence of intraocular gas.

The FLAP CONE mnemonic demonstrates excellent diagnostic accuracy and interobserver reliability, providing a systematic and efficient approach to the CT evaluation of globe rupture.