Radiographically occult scaphoid fractures: value of MR imaging in detection.

Breitenseher, Martin; Metz, V.; Gilula, Louis A.; Gaebler, Christian; C, Kukla; Fleischmann, Dominik; Imhof, H; Trattnig, Sigfried

doi:10.1148/radiology.203.1.9122402

Cited by 187 publications

(86 citation statements)

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“…By using E-MRT, we found 18 more occult fractures in 47 patients. This is in agreement with other studies, which reported occult fractures of the carpal bones detection of in up to half of the patients, using whole-body MR scanners (Gaebler et al 1996, Breitenseher et al 1997, Hunter et al 1997.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Diagnosis of scaphoid fracture and dedicated extremity MRI

Bretlau¹,

Christensen

Edstrom³

et al. 1999

Acta Orthopaedica Scandinavica

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Section: Discussionsupporting

confidence: 93%

“…Whole-body MRI of the wrist (Imaeda et al 1992) has been reported to be better than other modalities for diagnosing fractures of the carpal bones (Lepisto et al 1995, Gaebler et al 1996, Breitenseher et al 1997). …”

mentioning

confidence: 99%

Diagnosis of scaphoid fracture and dedicated extremity MRI

Bretlau¹,

Christensen

Edstrom³

et al. 1999

Acta Orthopaedica Scandinavica

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“…First, we included only studies published as a full report in English. We identified three potentially eligible nonEnglish studies [8,31,33], two of which [8,31] involved potential overlap of patient population with an included study [7]. Second, we did not test for publication bias, which hampers most metaanalyses of diagnostic tests [45].…”

Section: Discussionmentioning

confidence: 99%

Diagnosing Suspected Scaphoid Fractures: A Systematic Review and Meta-analysis

Yin

Zhang

Kan

et al. 2010

Clinical Orthopaedics &Amp; Related Research

139

152

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Imaging protocols for suspected scaphoid fractures among investigators and hospitals are markedly inconsistent. We performed a systematic review and metaanalysis to assess and compare the diagnostic performance of bone scintigraphy, MRI, and CT for diagnosing suspected scaphoid fractures. Twenty-six studies were included. Sensitivity, specificity, and diagnostic odds ratio were pooled separately and summary receiver operating characteristic curves were fitted for each modality. Metaregression analyses were performed to compare these modalities. We obtained likelihood ratios derived from the pooled sensitivity and specificity and, using Bayes' theorem, calculated the posttest probability by application of the tests. The pooled sensitivity, specificity, natural logarithm of the diagnostic odds ratio, and the positive and negative likelihood ratios were, respectively, 97%, 89%, 4.78, 8.82, and 0.03 for bone scintigraphy; 96%, 99%, 6.60, 96, and 0.04 for MRI; and 93%, 99%, 6.11, 93, and 0.07 for CT. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. We believe additional studies are needed to assess diagnostic performance of CT, especially paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy.

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“…38,64,72,74,75,88,91,[95][96][97][98][99][100] Investigators reported a variety of criterion standards, including clinical evalua- Figure 12. Ultrasound forest plots.…”

Section: Mrimentioning

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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Radiographically occult scaphoid fractures: value of MR imaging in detection.

Abstract: 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.

Cited by 187 publications

References 0 publications

Diagnosis of scaphoid fracture and dedicated extremity MRI

Diagnosis of scaphoid fracture and dedicated extremity MRI

Diagnosing Suspected Scaphoid Fractures: A Systematic Review and Meta-analysis

Adult Scaphoid Fracture

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