Comparison of CT and MRI for Diagnosis of Suspected Scaphoid Fractures

Mallee, Wouter H.; Doornberg, Job N.; Ring, David; Dijk, C. Niek van; Maas, Mario; Goslings, J. Carel

doi:10.2106/jbjs.i.01523

Cited by 104 publications

(89 citation statements)

References 34 publications

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“…A fracture gap or trabecular impaction has to be visible in several adjoining slices [7,14,15]. If, however, there is no dislocation of the compact and spongy bone, the fracture cannot be detected, even using CT [16]. In the rare case that MRI is used to detect or exclude fracture, its sensitivity is 100 % ("no fracture missed"), but its specificity -80 to 90 % -is lower than CT [17].…”

Section: Resultsmentioning

confidence: 99%

“…▶ Post-traumatic diffuse edema without indication of a fine, generally hypointense fracture line or a gaping fracture represents a bone bruise to the scaphoid [16,18]. A bone bruise is a microtrabecular infraction without destabilizing discontinuity.…”

Section: Resultsmentioning

confidence: 99%

“…Scaphoid fracture may not be diagnosed in MRI without evidence of a fracture line or gap in several adjacent slices. The disadvantage of MRI compared to CT is its specificity of only 80 to 90 % in the correlation of a pathological bone marrow signal with a scaphoid fracture or bone bruise [16,18].…”

Section: Resultsmentioning

confidence: 99%

“…The situation is biomechanically stable. Display of small avulsion fragments is poorer in MRI compared to CT [16,18]. A supplementary CT is recommended to exclude or confirm a scaphoid fracture and to provide classification if needed if there is planar bone marrow edema and a questionable fracture gap.…”

Section: Resultsmentioning

confidence: 99%

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Imaging of Scaphoid Fractures According to the New S3 Guidelines

Schmitt

Rosenthal

Unfallchirurgie³

2016

Fortschr Röntgenstr

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▼Up to 30 % of acute scaphoid fractures are missed in conventional radiography. CT and MRI should be early performed in the diagnostic workflow, when radiograms (dorsopalmar, lateral and Stecher's views) are negative or inconclusive in fracture detection. Significance of CT is different from that of MRI: Sensitivity of CT imaging (85 to 95 %) is superior to conventional radiography (about 70 %), but inferior to MRI (almost 100 %). However, CT (specificity 95 to 100 %) is able to provide more detailed anatomic information of the fracture pattern when compared to MRI (specificity 80 to 90 %). Particularly, differentiation of bone contusion ("bone bruise") and non-displaced fracture can be difficult in MRI. Thus, CT indication is not only given for fracture detection, but also for assessing the morphology in scaphoid fractures (localization, fragment dislocation, comminuted zones) and the fragment instability, too. MRI should be limited to equivocal trauma cases presenting pain in the snuff box, but with inconclusive CT findings. In CT and MRI of scaphoid fractures, image display must be aligned along the longitudinal extension of the scaphoid, either by acquiring or reformatting oblique-sagittal and obliquecoronal planes. Key points ▶ Radiography can be limited to the dorsopalmar, lateral and Stecher's views in scaphoid fractures.▶ In CT and MR imaging, the dedicated anatomy of the scaphoid has to be covered with oblique-sagittal and oblique-coronal images.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Imaging of Scaphoid Fractures According to the New S3 Guidelines

Schmitt

Rosenthal

Unfallchirurgie³

2016

Fortschr Röntgenstr

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“…This is supported by the fact that scaphoid fractures relatively commonly lead to non-union due to the limited vascularization of the scaphoid bone. Therefore, additional imaging such as MRI, bone scintigraphy or CT scanning is frequently used in order not to miss the diagnosis [2,3]. Treatment consists of prolonged immobilization or osteosynthesis and screw fi xation.…”

Section: Introductionmentioning

confidence: 99%

The Natural History of a Missed Scaphoid Fracture

Musters

2011

J Med Cases

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Scaphoid fractures are known to be a diffi cult diagnosis since they can be accompanied by unspecifi c physical complaints. Furthermore, they are diffi cult to visualize on standard x-ray examinations. The purpose of this report is to stress the importance of adequate diagnosis and treatment of scaphoid fractures. We describe a 50-year old female, with progressive wrist pain after a skiing accident, who was diagnosed with an untreated scaphoid fracture. This scaphoid fracture had developed into a scaphoid non-union advanced collapse of the wrist. The scaphoid non-union advanced collapse was treated with a four-corner arthrodesis and a Wafer procedure, which ultimately led to an acceptable situation. This report presents a rare complication of a missed scaphoid fracture. X-rays of the wrist commonly fail to demonstrate fractures of the scaphoid bone. Therefore more invasive imaging techniques must be used to diagnose a scaphoid fracture.

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