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Three Part Question

In [adult patients with acute anatomical snuff box tenderness] is [computed tomography better than magnetic resonance imaging] at [diagnosing fractures of the scaphoid]?

Clinical Scenario

You see a thirty year old male colleague who has fallen on to his dominant outstretched hand. He is complaining of tenderness in his anatomical snuffbox. His scaphoid views do not show an obvious fracture, but he is reluctant to be in a splint for a fortnight. He asks you if there is any role for further imaging to rule out a fracture. You wonder whether CT would be better than MRI at diagnosing a scaphoid fracture

Search Strategy

Medline 1980 to present day using EMBASE interface
Cochrane Library Issue 1 2009

EMBASE search: [exp scaphoid fracture/OR exp scaphoid injury.ti.ab] AND [EXP magnetic resonance imaging/OR computed tomography.ti.ab] Limited to human and English language
Cochrane Library search: diagnosis scaphoid fracture CT MRI

Search Outcome

Two papers were found that were directly relevant to the three part question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Memarsadeghi et al 2006 Austria	29 patients with acute scaphoid pain after trauma	Prospective diagnostic study	Diagnosis of occult fracture	No statistical difference between CT and MRI for detection of scaphoid fractures (p=0.25). CT better at detecting cortical involvement (p=0.03)	Small study size
Kusano et al 2002 Japan	52 adult patients with suspected scaphoid fracture after trauma	Prospective diagnostic study	Diagnosis of occult fracture	100% sensitivity with both CT and MRI	Small study size Not all patients with a fracture detected on MRI had a CT (16/18)

Comment(s)

One paper shows that CT is statistically significantly better than MRI at diagnosing cortical involvement, but is not significantly better at overall diagnosis of occult scaphoid fracture. Both CT and MRI are useful tools for diagnosis of occult scaphoid fracture. CT is quicker to perform, and is more likely to be readily available.

Clinical Bottom Line

There is no evidence to suggest that CT is better than MRI at the overall diagnosis of occult scaphoid fractures.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

1. Memarsadeghi M, Breitensher M, Schaefer-Prokop C, Weber M, Aldrian S, Gabler C, Prokop M Occult Scaphoid Fractures: Comparison of Multidetector CT and MR Imaging - Initial Experience Radiology 2006; 240: 169-176
2. Kusano N, Churei Y, Shiraishi E, Kusano T Diagnosis of occult scaphoid fracture: a comparison of magnetic resonance imging and computed tomography techniques Techniques in Hand and Upper Extremity Surgery 2002; 6: 119-123