Single-sequence low-field 3D T1-weighted MRI for scaphoid fracture detection compared to radiography: prospective...

To determine the diagnostic accuracy of a novel high-resolution 3D T1-weighted gradient-echo sequence in low-field MRI for detecting scaphoid fractures compared with radiography.

In this prospective single-center study, patients with suspected scaphoid injury underwent wrist radiography and 0.31 T extremity MRI including a 4-min 3D gradient-echo sequence (3D SST1). Three musculoskeletal radiologists independently evaluated radiographs and the isolated 3D sequence in separate sessions, rating fracture presence, displacement/stability, diagnostic confidence (five-point Likert scale), and need for additional imaging. The reference standard was based on CT and standard MRI sequences, evaluated by two experienced musculoskeletal radiologists.

Forty patients with 11 scaphoid fractures were included. Across readers, AUC for scaphoid fracture detection was 1.000 for 3D MRI and 0.823 for radiography (AUC-difference 0.177, 95% CI: -0.004-0.359, p = 0.056). For 3D MRI, sensitivity and NPV were 1.000 for all readers. Specificity (0.931-0.966 vs 0.655-0.862) and PPV (0.846-0.917 vs 0.444-0.667) were higher than for radiography. Diagnostic confidence was excellent (median score 1) with near-perfect inter-rater agreement (κ = 0.961). Additional imaging was not recommended in 40/36/37 cases (reader 1/2/3).

A single 4-min high-resolution 3D low-field MRI sequence enabled highly accurate detection of scaphoid fractures with perfect sensitivity and NPV, a high reader confidence, and an improved performance compared to radiography in this small pilot cohort. This approach may facilitate rapid, radiation-free screening in acute wrist trauma.