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Comparison of MRI, CT and bone scintigraphy for suspected scaphoid fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The best diagnostic modality for confirmation of the diagnosis of a scaphoid fracture that is not visible on the initial radiograph (occult scaphoid fracture) is still subject of debate. The aim of this study was to compare the accuracy of magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy (BS) for the diagnosis of these occult scaphoid fractures.

Patients and methods

In a study period of 12 months, 33 consecutive patients with a clinically suspected scaphoid fracture without a fracture on the scaphoid radiographs were evaluated with MRI, CT and BS. In case of a discrepancy between the diagnostic modalities, the final diagnosis was based on standardised follow-up with clinical examination and a repeated radiograph.

Results

Three of the 33 patients had a scaphoid fracture. MRI missed one scaphoid fracture and did not over-diagnose. CT missed two scaphoid fractures and did not over-diagnose. BS missed no scaphoid fractures and over-diagnosed one scaphoid fracture in a patient with a fracture of the trapezium.

Conclusion

This study shows that neither MRI, nor CT and BS are 100 % accurate in diagnosing occult scaphoid fractures. MRI and CT miss fractures, and BS tends to over-diagnose. The specific advantages and limitations of each diagnostic modality should be familiar to the treating physicians and taken into consideration during the diagnostic process.

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Author information

Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Centre, Postbus 9600, 2300 RC, Leiden, The Netherlands

    A. D. de Zwart, K. Bartlema & I. B. Schipper

  2. Deparment of Surgery, Luzerner Kantonsspital, 6006, Lucerne, Switzerland

    F. J. P. Beeres

  3. Department of Surgery, Medical Centre Haaglanden, 2512 VA, The Hague, The Netherlands

    S. J. Rhemrev

  4. Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands

    A. D. de Zwart

Authors
  1. A. D. de Zwart
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  2. F. J. P. Beeres
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  3. S. J. Rhemrev
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  4. K. Bartlema
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  5. I. B. Schipper
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Corresponding author

Correspondence to A. D. de Zwart.

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Conflict of interest

Andele D. de Zwart, Frank J.P. Beeres, MD, PhD, Steven J. Rhemrev, Kees Bartlema and Inger B. Schipper declare that they have no conflict of interest.

Research involving human participants

This study was approved by the Medical Ethics Committee of the Leiden University Medical Center (Protocol Number P06.044).

Informed consent

The patients participating in this study provided written informed consent.

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de Zwart, A.D., Beeres, F.J.P., Rhemrev, S.J. et al. Comparison of MRI, CT and bone scintigraphy for suspected scaphoid fractures. Eur J Trauma Emerg Surg 42, 725–731 (2016). https://doi.org/10.1007/s00068-015-0594-9

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  • DOI: https://doi.org/10.1007/s00068-015-0594-9

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