The incidence of MRI detected scaphoid and other wrist fractures was determined in a clinical setting in patients with suspicion of scaphoid injury and negative initial radiographs. The influence on subsequent patient management was examined. Patients attending Accident and Emergency over a 25 month period with suspected scaphoid fracture and normal scaphoid series plain films were referred for wrist MRI. Scans comprising T(1) weighted spin echo and short tau inversion recovery (STIR) coronal sequences were performed in a dedicated extremity low field MRI scanner within 14 days of injury. Subsequent effects on patient management were ascertained by clinician completed questionnaire. 195 patients were scanned. There were 37 scaphoid fractures (19%), 28 distal radius fractures (14%), 9 fractures of other carpal bones (5%) and 119 studies with no fracture. The management of 180 patients (92%) was altered as a result of the MRI scan. Occult fractures are present in almost two fifths of patients with suspected scaphoid fracture and normal initial plain films. Half of these are scaphoid fractures. MRI allows an early definitive diagnosis to be made, changing patient management in over 90% of cases and should be regarded as the gold standard investigation in this population.

Diffuse coronary artery disease is an important predictor of morbidity and mortality in primary and REOP CABG patients, and should be considered in both individual patient assessment and risk adjustment.

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V entricular aneurysms and diverticula are rare entities. In the case presented, left ventriculography reveals multiple thumblike projections from the left ventricular myocardium (arrows) (A, Online Video 1). Cardiac magnetic resonance imaging confirms the presence of multiple left ventricular diverticula (large arrow) and aneurysm (small arrow) (B, Online Video 2). The large akinetic inferobasal aneurysm is the best demonstrated lesion. Perfusion and delayed enhanced sequences demonstrate hypoperfusion and delayed enhancement in the apex of the aneurysm, which is consistent with fibrosis or scar. Multiple anterior wall diverticula were also demonstrated. The magnetic resonance imaging confirmed normal myocardium surrounding these contractile aneurysms.