Magnetic resonance imaging of suspected scaphoid fractures using a low field dedicated extremity MR system

To determine whether magnetic resonance imaging (MRI) using a dedicated extremity system could be utilized for the routine assessment of patients with a clinically suspected scaphoid fracture, and to determine the most cost-effective timing of MRI for these patients.

MRI of the wrist using a 0.2T extremity MR system was performed in two groups of patients. Fifty-six patients were examined within 4 days of injury and 53 with persistent symptoms at 10 days to 6 weeks following injury. A scaphoid series of radiographs was negative in both groups.

The early MR group had seven scaphoid, six radial and four other fractures. Management was altered in 89%. The late MR group had 14 scaphoid, nine radial and three other fractures. Management was altered in 69%. A cost model showed that overall costs are less with early rather than late scanning.

MRI of the wrist when scaphoid fracture is suspected can be undertaken in all patients with negative radiographs and could be performed in most departments with an MRI machine. There are significant patient benefits and overall costs would change little from conventional practice.