2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Preliminary Study of Integrating ZTE MRI in Proximal Humerus Fractures: Bridging the Gap Between CT and MRI

Mehmet Kaymakoglu, M.D, Izmir TURKEY
Ulaş Can Kolaç, MD, Ankara TURKEY
Gökhan Ayik, PhD, Ankara TURKEY
Serkan Ibik, MD TURKEY
Erdi Ozdemir, MD, Hershey UNITED STATES
Gazi Huri, Prof. MD, Doha QATAR

Hacettepe University, Ankara, TURKEY

FDA Status Cleared

Summary

This study suggests that zero echo time (ZTE) MRI is a viable alternative to CT for assessing proximal humerus fractures, providing comparable morphologic details along with additional soft tissue information and reducing patient radiation exposure.

Abstract

Aim

This study aims to evaluate the efficacy and accuracy of zero echo time (ZTE) magnetic resonance Imaging (MRI) compared to computed tomography (CT) in the assessment of proximal humerus fractures (PHF). The primary objective is to establish the clinical applicability and diagnostic accuracy of ZTE MRI for these fractures.

Background

PHF represent a common orthopedic injury, particularly in older populations, with their diagnosis and management posing significant clinical challenges. Traditional imaging modalities, such as CT, have been the standard for evaluating these fractures, offering detailed bone morphology. However, the limitation in soft tissue visualization and the concern over radiation exposure call for alternative imaging strategies. ZTE MRI emerges as a promising technology, providing high-resolution images of both bone and soft tissue without ionizing radiation. This study investigates the potential of ZTE MRI to bridge the gap between the detailed morphological assessment provided by CT and the need for comprehensive soft tissue evaluation in PHF.

Methods

This retrospective study enrolled a cohort of 20 patients with suspected or confirmed PHF , who underwent both standard-of-care CT and ZTE MRI. Independent reviews of each patient's imaging were conducted by an orthopedic resident and an orthopedic consultant. The assessments focused on identifying fracture characteristics according to Neer classification, rotator cuff tears, bone marrow edema and additional soft tissue injuries.The detailed morphology of the fracture, alignment, joint surface involvement, and the diagnostic agreement between ZTE MRI and CT findings were evaluated to assess ZTE MRI's diagnostic accuracy. Concordance between ZTE MRI and CT findings was evaluated using Cohen’s kappa for inter-rater reliability

Results

Both imaging modalities demonstrated high agreement in fracture characterization, with ZTE MRI providing additional soft tissue information. The Intraclass Correlation Coefficient values, reflecting inter-rater reliability for the quantitative measurements, were consistently above 0.90, indicating substantial agreement. ZTE MRI showed comparable accuracy to CT in defining fracture patterns according to Neer and AO classifications and was particularly effective in identifying subtle fractures. It also reduced the patient's exposure to ionizing radiation. In some instances, ZTE MRI surpassed CT in revealing certain fracture details and associated soft tissue conditions.

Conclusion

ZTE MRI presents a viable alternative to CT in the evaluation of PHF. It offers comparable morphologic information with added soft tissue details, potentially reducing the reliance on CT and thereby minimizing radiation exposure. These findings suggest that ZTE MRI could be integrated into clinical protocols for a more comprehensive and less invasive assessment of PHF.