A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture

Fowler, Clare J.; Sullivan, B. Patrick; Williams, Lynn; McCarthy, Gerry; Savage, R.; Palmer, Andrew K.

doi:10.1007/s002560050459

Cited by 95 publications

(52 citation statements)

References 11 publications

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“…The timing of the bone scan relative to the injury ranged from less than 3 days 73 to 19 days. 74 Many studies failed to report the scintigraphy methods, but those that did provide detailed methods reported using 10-20 mCi (750 MBq) of technetium-99 m dimethylene phosphonate and a 3-hour delayed, three-phase bone scan with a pinhole study using a single-headed gamma camera. Three studies assessed the interrater reliability of bone scan.…”

Section: Bone Scanmentioning

confidence: 99%

“…38,64,72,74,75,88,91,[95][96][97][98][99][100] Investigators reported a variety of criterion standards, including clinical evalua- Figure 12. Ultrasound forest plots.…”

Section: Mrimentioning

confidence: 99%

“…tion at 14 days, 100 x-ray alone at 6 or 11 weeks, 88,98 x-ray plus clinical evaluation at 6 weeks, 95,96 MRI alone, 91,99 MRI plus x-ray, 38 or MRI plus x-ray and bone scan. 74 In most studies, MRI imaging used a 0.1-to 1.5-Tesla unit with two sequences: a coronal T1-weighted spin-echo and a coronal and transverse short-tau inversion recovery (STIR) sequence. Two studies also included a T2-weighted gradient-echo sequence.…”

Section: Mrimentioning

confidence: 99%

“…38,40,56,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] All of the pre-1995 studies used an x-ray/clinical examination composite as the criterion standard, although the timing of this follow-up evaluation ranged from 14 days to 1 year. After 1995, several studies also included MRI as an acceptable criterion standard.…”

Section: Bone Scanmentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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Section: Bone Scanmentioning

confidence: 99%

“…38,64,72,74,75,88,91,[95][96][97][98][99][100] Investigators reported a variety of criterion standards, including clinical evalua- Figure 12. Ultrasound forest plots.…”

Section: Mrimentioning

confidence: 99%

Section: Mrimentioning

confidence: 99%

Section: Bone Scanmentioning

confidence: 99%

See 2 more Smart Citations

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Fowler and colleagues compared bone scanning to MRI for diagnosing occult scaphoid fractures. 20 Of 43 patients, they identified 6 patients with scaphoid fractures and 6 with other types of fractures. Beeres and colleagues evaluated bone scans to identify occult scaphoid fractures.…”

Section: Discussionmentioning

confidence: 99%