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Radiographically occult scaphoid fractures: value of MR imaging in detection
M J Breitenseher1, V M Metz, L A Gilula
1Department of Radiology, University of Vienna, Austria.
Purpose:
To evaluate the diagnostic value of magnetic resonance (MR) imaging in patients with clinical suspicion of scaphoid fractures and normal initial plain radiographs.
Materials And Methods:
MR imaging was performed within 7 days after trauma in 42 patients with clinical suspicion of scaphoid fractures and normal plain radiographs. T1-weighted spin-echo, T2*-weighted gradient-echo, and short inversion time inversion-recovery (STIR) sequences were performed. MR images were evaluated independently by two radiologists. Six-week follow-up radiographs were used as a standard to diagnose fractures.
Results:
MR imaging depicted occult fractures of the scaphoid bone in 14 patients (33%), the capitate bone in four (10%), the trapezium in one (2%), and the distal radius in two (5%). All wrist fractures were detected with a combination of STIR and T1-weighted spin-echo sequences. The sensitivity and specificity for detection of radiographically occult fractures of the wrist were 100% each for the first and 95% and 100%, respectively, for the second radiologist with an almost perfect interobserver agreement (K = 0.953).
Conclusion:
MR imaging has a high sensitivity for detection of fractures of the scaphoid bone and wrist not evident on plain radiographs and may enable early diagnosis and treatment.