From the Guidelines
The best imaging modality to further assess rib lesions noted on chest X-ray is CT (computed tomography) scan with contrast. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of CT scans in characterizing rib lesions and detecting potential complications 1. CT scans provide superior anatomical detail of bone and soft tissue compared to X-ray, allowing for better characterization of rib lesions and identification of subtle fractures that may be missed on plain radiographs.
Some key points to consider when evaluating rib lesions include:
- The presence and number of rib fractures, as well as the degree of displacement, may carry prognostic significance 1
- CT scans can detect fracture-related complications that are radiographically occult, such as pneumothorax, subclavian vein injury, and chest wall hematomas 1
- Contrast-enhanced CT of the chest is the preferred imaging workup of suspected chest trauma, as it is more sensitive and specific for chest trauma than conventional radiographs 1
In cases where there is concern for bone marrow involvement or when CT findings are inconclusive, MRI may be considered as a complementary study 1. However, CT scan with contrast remains the primary recommended imaging modality for further assessing rib lesions noted on chest X-ray, due to its superior sensitivity and specificity for detecting chest trauma and characterizing rib lesions.
From the Research
Imaging Modalities for Rib Lesions
To further assess rib lesions noted on chest X-ray, the following imaging modalities can be considered:
- Computed Tomography (CT) scan: CT scan is more sensitive than chest X-ray in diagnosing rib fractures 2, 3
- Rib Radiography: Rib radiography can be used to diagnose rib fractures, but it may miss some fractures due to overlap with organs or fractures outside the imaging range 3
Characteristics of Rib Fracture Patients who Require Chest CT
Patients with the following characteristics may require chest CT:
- Multiple rib fractures (≥ 3) 4
- Bilateral rib fractures 4
- Lateral or posterior rib fractures 4
- Displacement of rib fractures 4
Diagnostic Performance of Chest CT
The diagnostic performance of chest CT in detecting rib fractures is as follows:
- High sensitivity and specificity in adults 2, 3
- Low sensitivity but high specificity in children, especially in post-mortem CT 5
Considerations for Imaging Modalities
When choosing an imaging modality, consider the following:
- CT scan is more sensitive than chest X-ray, but it may not be necessary for all patients with rib fractures 6, 2
- Rib radiography may be sufficient for some patients, but it may miss some fractures 3
- Patient characteristics, such as the number and location of rib fractures, should be taken into account when deciding on an imaging modality 4