Comparative evaluation of MRI-based bone-targeted sequences and computed tomography for preoperative assessment of midfacial trauma

This prospective study aimed to compare computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative assessment of acute midfacial trauma. Twenty patients received posttraumatic CT and MRI scans using a 3T scanner with a dedicated 15-channel dentomaxillofacial coil. Five MRI protocols were evaluated: UTE, DESS, Dark Bone, StarVIBE, and STIR. Three observers qualitatively assessed fracture detection, image quality, fracture line visibility, cortical delineation, and bone-to-soft-tissue contrast using a five-point scale. Descriptive statistics and inter-observer reliability (Krippendorff's α) were calculated. Forty-two fractures were analyzed. CT achieved excellent fracture detection (98% of fractures detected; α = 1.0) with the fastest evaluation times (30-82 s vs. 42-145 s). Among MRI protocols, UTE and StarVIBE performed best, detecting 88-89% of fractures, with excellent image quality and high inter-observer reliability (α = 0.80-0.91). Darkbone, DESS, and STIR consistently showed lower detection rates (up to 43%). UTE and StarVIBE were particularly effective for orbital, zygomaticomaxillary, and nasal bone fractures. Optimized gradient-echo-based MRI protocols provide radiation-free, CT-like imaging of midfacial fractures with superior soft-tissue contrast. While CT remains essential for emergency situations, a patient-, protocol-, and pathology-specific MR-based diagnostic approach offers a clinically feasible preoperative alternative in trauma management.Trial registration number: Swiss National Clinical Trials Portal: SNCTP000006343, ClinicalTrials.gov ID: NCT07012850 (trial registration date: May 9, 2025).