Early CT for suspected occult scaphoid fractures

Stevenson, Jonathan; Morley, D. J.; Srivastava, Subhash; Willard, C; Bhoora, I. G.

doi:10.1177/1753193411428993

Cited by 14 publications

(10 citation statements)

References 35 publications

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“…This is in concordance with recent reports supporting MDCT as a diagnostic modality of high diagnostic accuracy in scaphoid fracture detection [23][24][25][26] whereas in these reports radiography also was of limited value [23,25,27] . Stevenson et al [24] showed that using initial MDCT an occult scaphoid fracture can be ruled out with the patient returning to regular activity immediately. Acute scaphoid fractures are typically seen in young adults who fall on the outstretched hand [7,25] .…”

Section: Resultssupporting

confidence: 92%

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Behzadi

Karul

Henes

et al. 2015

WJR

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AIM:To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures. METHODS:One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities. RESULTS:Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid

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Section: Resultssupporting

confidence: 92%

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Behzadi

Karul

Henes

et al. 2015

WJR

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“…Although our data do not cover this clinical scenario, the CBCT, as a low-dose imaging technique, could also be considered a primary diagnostic tool in patients with clinically suspected scaphoid fracture. This has already been discussed for MDCT 20 . Further studies are necessary to evaluate this potential role of the CBCT.…”

Section: Discussionmentioning

confidence: 71%

Comparison of the diagnostic accuracy of cone beam computed tomography and radiography for scaphoid fractures

Neubauer

Benndorf

Ehritt-Braun

et al. 2018

Sci Rep

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The aim of this study was to evaluate and compare the diagnostic accuracy, the inter-rater agreement and raters’ certainty of cone beam computed tomography (CBCT) and radiography for the detection of scaphoid fractures. Our hypothesis is that the CBCT has a higher diagnostic accuracy for scaphoid fractures than radiography. We retrospectively analysed patients who underwent both radiography and CBCT examinations within 4 days to rule out a scaphoid fracture over a 2-year period in our institution. 4 blinded radiologists and orthopaedic surgeons independently rated the images regarding the presence of a scaphoid fracture. The reference standard was evaluated by two radiologists in a consensus reading. Inter-rater correlation was evaluated, pooled sensitivity, specificity, positive and negative predictive values were calculated and compared. 102 patients met the inclusion criteria. 52% of them had a scaphoid fracture. The inter-rater correlation was higher in the CBCT compared to radiography (P < 0.001). Sensitivity, specificity, positive and negative predictive values were higher for CBCT than for radiography (P < 0.019). Observers’ fracture classifications showed a higher correlation with the reference standard in the CBCT. Observers’ certainty for fracture detection and classification were higher in the CBCT. CBCT shows a higher diagnostic accuracy for scaphoid fractures than radiography.

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“…Regardless, a radiograph is usually carried out first in the clinical case of suspected fractures of the wrist [2]. Some authors argue that despite the increased radiation exposure early evaluation of clinically suspected fractures should be performed with CT if the radiograph appears normal [26]. This would avoid unnecessary immobilization and also prevent the delayed diagnosis of fractures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

et al. 2016

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PurposeTo compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures.MethodsAs study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.ResultsPooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities’ specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001).ConclusionThe diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

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Early CT for suspected occult scaphoid fractures

Cited by 14 publications

References 35 publications

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Comparison of the diagnostic accuracy of cone beam computed tomography and radiography for scaphoid fractures

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

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