Role of Multidetector Computed Tomography (MDCT) with MPR in Assessment of Fracture Patterns Around the Wrist Join

Abstract

Background: Imaging of the wrist is challenging to both radiologists and orthopedic surgeons. This is primarily because of the complex anatomy/functionality of the wrist and also the fact that many frequent injuries are sustained to the hands. Ongoing developments in multidetector computed tomography (MDCT) technology with its "state of the art" postprocessing capabilities have revolution-nized this field. This article pictorially reviews the current clinical role of MDCT imaging of wrist in our practice. Objective: The aim of this work is to study the role of multidetector computed tomography (MDCT) with multi-planar reconstruction in the assessment of fracture patterns around the wrist joint. Patients and methods: Forty patients with fractures around the wrist (diagnosed both clinically and radiologically through plain radiography in the ER) were referred from the orthopedic surgery department for CT evaluation. The study was conducted in the Radiology department at Minia University Hospital during the period from May to December 2018. All patients were enrolled after meeting the inclusion criteria and after having individually written informed consent. The standard CT protocol performed for all patients was as follows: By using 16 slice MDCT machines. Imaging the wrist with the following parameters: 0.625-mm collimation, a pitch of 0.5625, 120 kVp, and 200 mA.512x 512 array field-of-view (FOV), and 1 pitch factor. No patient preparation was needed as no contrast media was indicated in the study. Removal of metallic objects was a routine procedure to avoid metallic artifacts. Results: most of the patients were below the age of 37 years, 67.5% of the studied patients were males and the left side is more affected than the right side. The most common cause of fractures around the wrist is falling on outstretched hand which was statistically superior to other mechanisms (75%). Radiography and CT detect all cases of distal radius fractures while in ulna fractures radiography sensitivity to fracture was 88.2%, in scaphoid fractures sensitivity was 50% while in capitate fracture radiography cannot detect fracture 0% sensitivity. So, CT has the upper hand in the detection of occult fractures. Conclusion: Wrist fractures and dislocations may be overlooked on conventional radiographs. CT with multiplanar and volumetric reformation can be a useful technique to demonstrate occult carpal bone fractures. Also, it can illustrate the complexity and extent of fractures as well as joint dislocations.