Failure of bone scanning to detect fractures in a woman on chronic steroid therapy

Scott, S. M.; Alazraki, Naomi P.; Manaster, B.J.

doi:10.1007/bf00361089

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…Poor renal function is suspected of contributing to reduced tissue clearance of the radionuclide, with resultant poor images. Scott et al [19] reported a case in which a 33-year-old post-renal-transplant patient sustained an acute intertrochanteric fracture which bone scan did not detect. The diagnosis was made with plain film polytomography and the patient underwent surgical repair.…”

Section: Discussionmentioning

confidence: 97%

Magnetic resonance imaging of occult fractures of the proximal femur

et al. 1994

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The evaluation of the painful hip in the elderly osteoporotic patient with normal plain radiographs can be difficult. We studied 15 osteopenic patients with normal plain radiographs and suspected hip fractures with magnetic resonance (MR) imaging and found MR to be an excellent aid in detecting occult fractures. A clear fracture was seen in 10 of the 15 patients, who then underwent surgical repair based on the MR study. The remaining patients had no MR-demonstrable fracture and were successfully treated nonoperatively. Some believe that a negative bone scan in this population of patients should be repeated within 3 days prior to a definitive "no fracture" decision being made. Unfortunately, bone scanning lacks spatial resolution, and increased osteoblastic activity may be caused by other pathologic processes besides fracture. Two of the 15 patients had MR-demonstrated bone infarcts near the fracture. One patient also had femoral head osteonecrosis on the side of the fracture. One patient with metastatic prostatic carcinoma had a hip fracture and one patient with metastatic breast carcinoma had no fracture. No only is MR imaging an excellent technique for delineating occult fractures, but due to its spatial resolution, associated bone disorders adjacent to fractures can be detected in most instances. From a cost perspective, rapid diagnosis and early treatment of an occult femoral fracture is advisable. A reduced hospital stay pending diagnosis and the early institution of definitive therapy also decrease the chance that a simple non-displaced fracture will displace and require more complex management with resultant increased morbidity and cost.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 97%

Magnetic resonance imaging of occult fractures of the proximal femur

et al. 1994

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“…Although the bone scan is considered the most sensitive method for detecting stress fractures [21], it involves ionizing radiation and its use for monitoring stress fracture healing was discouraged by Moran et al [18]. An additional limitation of this and other imaging tools used for stress fracture diagnosis (eg, MRI, CT, or conventional bone radiography) is that they may not be readily available in the field, particularly for soldiers in training presenting with symptoms compatible with stress fractures.…”

Section: Introductionmentioning

confidence: 99%

Bone Turnover Markers Do Not Predict Stress Fracture in Elite Combat Recruits

Yanovich¹,

Evans

Friedman

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Bone scintigraphy is not recommended in acute trauma. MRI is quicker and more specific (30,31) and there is a risk of false negative outcome when bone scanning is performed too early, especially in elderly patients and in patients with metabolic diseases (32)(33)(34). However, in stress fracture bone scintigraphy is a highly sensitive imaging modality.…”

Section: Discussionmentioning

confidence: 99%

A computer-assisted systematic quality monitoring method for cervical hip fracture radiography

Geijer

Laurin²,

Johnsson

et al. 2016

Acta Radiologica Open

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BackgroundA thorough quality analysis of radiologic performance is cumbersome. Instead, the prevalence of missed cervical hip fractures might be used as a quality indicator.PurposeTo validate a computer-based quality study of cervical hip fracture radiography.Material and MethodsTrue and false negative and positive hip trauma radiography during 6 years was assessed manually. Patients with two or more radiologic hip examinations before surgery were selected by computer analysis of the databases. The first of two preoperative examinations might constitute a missed fracture. These cases were reviewed.ResultsOut of 1621 cervical hip fractures, manual perusal found 51 (3.1%) false negative radiographic diagnoses. Among approximately 14,000 radiographic hip examinations, there were 27 (0.2%) false positive diagnoses. Fifty-seven percent of false negative reports were occult fractures, the other diagnostic mistakes. There were no significant differences over the years. Diagnostic sensitivity was 96.9% and specificity 99.8%. Computer-assisted analysis with a time interval of at least 120 days between the first and the second radiographic examination discovered 39 of the 51 false negative reports.ConclusionCervical hip trauma radiography has high sensitivity and specificity. With computer-assisted analysis, 76% of false negative reports were found.

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Failure of bone scanning to detect fractures in a woman on chronic steroid therapy

Cited by 7 publications

References 14 publications

Magnetic resonance imaging of occult fractures of the proximal femur

Magnetic resonance imaging of occult fractures of the proximal femur

Bone Turnover Markers Do Not Predict Stress Fracture in Elite Combat Recruits

A computer-assisted systematic quality monitoring method for cervical hip fracture radiography

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