Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

Daniels, Anne; Bevers, Melissa S. A. M.; Sassen, Sander; Wyers, Caroline E.; Rietbergen, Bert van; Geusens, Piet; Kaarsemaker, Sjoerd; Hannemann, Pascal F.W.; Poeze, Martijn; Bergh, Joop van den; Janzing, H

doi:10.2106/jbjs.20.00124

Cited by 12 publications

(8 citation statements)

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“…The CT also has a high specificity but a lower sensitivity; however, it is often preferred to the MRI as it is cheaper and more readily available (1,4,5). High-resolution peripheral quantitative computed tomography (HR-pQCT) represents an innovative option in detecting scaphoid fractures (6)(7)(8). Since the first results have only recently been published, its use is not yet widely established in this field.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the high resolution, small fissures in the scaphoid bone can be detected more sensitively than with the conventional CT (6,22). Furthermore, the analysis of the bone mineral density and micro-architecture could help to provide insights into fracture mechanisms, the non-union etiology (7), and its biology (23) and quantify the healing process of scaphoid fractures (16).…”

Section: Introductionmentioning

confidence: 99%

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The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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Background: In-vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) has high potential in scaphoid bone pathologies' scientific and clinical fields. The manufacturer's visual grading scale (VGS) classifies motion artifacts and divides scans into five quality grades ranging from grade 1 (good quality) to grade 5 (poor quality). This prospective study aimed to investigate the feasibility of the VGS and the influence of image quality on bone density and microarchitecture parameters for the scaphoid bone.Methods: Within one year, twenty-two patients with scaphoid fractures received up to six scans of their fractured and contralateral wrist (each consisting of three stacks) using second-generation HR-pQCT (total 256 scans). Three experienced observers graded each stack following the visual grading system, and interand intraobserver variability were assessed. The contralateral uninjured scaphoids were then compared pairwise within each patient to high-quality grade 1 scans to determine the influence of image quality on density and microarchitecture parameters.Results: Inter-and intraobserver variability among the three observers significantly revealed fair to moderate agreement, P<0.001 and P<0.05, respectively. Bone volume (BV) fraction tended to increase with poorer image quality but did not exceed four percent. Trabecular bone mineral density (Tb.BMD) decreased with poorer image quality but did not exceed five percent. Trabecular number and trabecular thickness significantly increased by 15.5% and 6.8% at grade five (P<0.001), respectively, and trabecular separation significantly decreased by 13.7% at grade five (P<0.001).Conclusions: This study revealed a considerable influence of motion on bone morphometry parameters of the scaphoid. Therefore, high image quality must be a central point in studies focusing on the histomorphometry of small objects. The high inter-and intraobserver variability limit the VGS. Future research may focus on other grading systems or automated techniques leading to more consistent and reproducible results. Currently, the use of microarchitectural analysis should be limited to cases without motion artefacts or, at most low graded motion artefacts.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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“…The patient's forearm was placed in an anatomically shaped motion-restraining holder to obtain a standardized position. Detailed information regarding the scanning procedures, image reconstruction, and fracture assessment was described previously [7,15].…”

Section: Hr-pqctmentioning

confidence: 99%

“…High-resolution peripheral quantitative CT (HR-pQCT), a novel imaging technique that allows an assessment of the microstructure of cortical and trabecular bone at the distal radius and tibia, has recently been introduced [11, 13, 17-19, 31, 39]. Because there is no consensus regarding the reference imaging technique for diagnosing scaphoid fractures, we have studied HR-pQCT as a diagnostic tool and have shown that it is feasible [7, 16] and superior [15] to CT for detecting fractures in patients with a clinically suspected scaphoid fracture. Therefore, we compared the results of conventional radiographs and clinical reassessment with HR-pQCT in this study.…”

Section: Introductionmentioning

confidence: 99%

What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?

Daniels

Kranendonk

Wyers

et al. 2022

Clin Orthop Relat Res

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BackgroundConventional radiographs and clinical reassessment are considered guides in managing clinically suspected scaphoid fractures. This is a unique study as it assessed the value of conventional radiographs and clinical reassessment in a cohort of patients, all of whom underwent additional imaging, regardless of the outcome of conventional radiographs and clinical reassessment.Questions/purposes(1) What is the diagnostic performance of conventional radiographs in patients with a clinically suspected scaphoid fracture compared with high-resolution peripheral quantitative CT (HR-pQCT)? (2) What is the diagnostic performance of clinical reassessment in patients with a clinically suspected scaphoid fracture compared with HR-pQCT? (3) What is the diagnostic performance of conventional radiographs and clinical reassessment combined compared with HR-pQCT?MethodsBetween December 2017 and October 2018, 162 patients with a clinically suspected scaphoid fracture presented to the emergency department (ED). Forty-six patients were excluded and another 25 were not willing or able to participate, which resulted in 91 included patients. All patients underwent conventional radiography in the ED and clinical reassessment 7 to 14 days later, together with CT and HR-pQCT. The diagnostic performance characteristics and accuracy of conventional radiographs and clinical reassessment were compared with those of HR-pQCT for the diagnosis of fractures since this was proven to be superior to CT scaphoid fracture detection. The cohort included 45 men and 46 women with a median (IQR) age of 52 years (29 to 67). Twenty-four patients with a median age of 44 years (35 to 65) were diagnosed with a scaphoid fracture on HR-pQCT.ResultsWhen compared with HR-pQCT, conventional radiographs alone had a sensitivity of 67% (95% CI 45% to 84%), specificity of 85% (95% CI 74% to 93%), positive predictive value (PPV) of 62% (95% CI 46% to 75%), negative predictive value (NPV) of 88% (95% CI 80% to 93%), and a positive and negative likelihood ratio (LR) of 4.5 (95% CI 2.4 to 8.5) and 0.4 (95% CI 0.2 to 0.7), respectively. Compared with HR-pQCT, clinical reassessment alone resulted in a sensitivity of 58% (95% CI 37% to 78%), specificity of 42% (95% CI 30% to 54%), PPV of 26% (95% CI 19% to 35%), NPV of 74% (95% CI 62% to 83%), as well as a positive and negative LR of 1.0 (95% CI 0.7 to 1.5) and 1.0 (95% CI 0.6 to 1.7), respectively. Combining clinical examination with conventional radiography produced a sensitivity of 50% (95% CI 29% to 71%), specificity of 91% (95% CI 82% to 97%), PPV of 67% (95% CI 46% to 83%), NPV of 84% (95% CI 77% to 88%), as well as a positive and negative LR of 5.6 (95% CI 2.4 to 13.2) and 0.6 (95% CI 0.4 to 0.8), respectively.ConclusionThe accuracy of conventional radiographs (80% compared with HR-pQCT) and clinical reassessment (46% compared with HR-pQCT) indicate that the value of clinical reassessment is limited in diagnosing scaphoid fractures and cannot be considered directive in managing scaphoid fractures. The com...

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“…To do this, we need a trustworthy gold standard against which we can test those alternatives. Current studies [1,2,4] have shown the superiority of highresolution peripheral quantitative CT over conventional CT; therefore, this method might serve us well as a gold standard when evaluating other diagnostic methods.…”

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confidence: 99%

CORR Insights®: What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?

Schiffer

2022

Clin Orthop Relat Res

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Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

Cited by 12 publications

References 55 publications

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?

CORR Insights®: What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?

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