Bone scintigraphy in the management of X-ray-negative potential scaphoid fractures.

Wilson, Amanda; Kurer, M. H. J.; Peggington, J. L.; Grant, David; Kirk, C. C. J.

doi:10.1136/emj.3.4.235

Cited by 15 publications

(3 citation statements)

References 16 publications

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“…Specifically we selected the following values: 0.78 [6] for sensitivity and 0.52 [27] for specificity of bone scintigraphy; 0.8 [5] for sensitivity and 0.95 [19] for specificity of MRI; and 0.05 for prevalence of true fractures among suspected scaphoid fractures [37] (Appendix 1).…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Buijze

Mallee

Beeres

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Section: Methodsmentioning

confidence: 99%

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Buijze

Mallee

Beeres

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…38,40,56,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] All of the pre-1995 studies used an x-ray/clinical examination composite as the criterion standard, although the timing of this follow-up evaluation ranged from 14 days to 1 year. After 1995, several studies also included MRI as an acceptable criterion standard.…”

Section: Bone Scanmentioning

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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“…Among the advanced diagnostic modalities for this specific patient group, PBS is favored for its high sensitivity in confirmation of scaphoid fractures. The disadvantage of PBS, however, is its lower specificity compared to MRI and CT ( 9 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture

Zwart

Beeres

Rietbergen

et al. 2015

Acta Radiologica Open

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Background *Equal contributors.Planar bone scintigraphy (PBS) is often advocated for diagnosing occult scaphoid fractures. PBS is a sensitive diagnostic modality, but lacks specificity, which may result in over-diagnosis.PurposeTo examine, in a pilot study, the potential additional value of single photon emission computed tomography (SPECT) combined with low dose computed tomography (CT) for the diagnosis of an occult scaphoid fracture.Material and MethodsTen patients that underwent combined PBS and SPECT/CT for a clinically suspected scaphoid fracture, where radiographs could not detect a fracture, were included in this pilot study. The PBS and SPECT/CT results were independently and separately evaluated by a nuclear physician for scaphoid fractures and other injuries.ResultsPBS was positive for a scaphoid fracture in four patients and diagnosed three other fractures. SPECT/CT showed five scaphoid fractures and one other fracture. SPECT/CT – PBS had discrepant results in three patients. In two patients PBS diagnosed a trapezoid fracture where SPECT/CT showed a scaphoid fracture. The other patient was diagnosed with a scaphoid fracture on PBS, whereas SPECT/CT showed bone bruise of other carpal bones.ConclusionSPECT/CT has the potential to be more accurate than PBS as it uses anatomical information of the CT to discriminate between the scaphoid, other carpal bones, and bone bruises. Larger studies with an independent reference standard are needed for confirmation of these preliminary data.

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Bone scintigraphy in the management of X-ray-negative potential scaphoid fractures.

Cited by 15 publications

References 16 publications

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Adult Scaphoid Fracture

Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture

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