MRI scans versus CT scan in diagnosing scaphoid fractures with normal X-ray results
Date First Published:
July 16, 2010
Last Updated:
July 16, 2010
Report by:
Zinnirah Zainodin, Medical student (University of Manchester)
Three-Part Question:
In [adult patients with a suspected scaphoid fracture], is [MRI is better than CT scan] in [diagnosing the fracture with an initially negative X-ray result]?
Clinical Scenario:
A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient undergo another investigation, such as an MRI, there and then?
Search Strategy:
Ovid MEDLINE(R) 1950 to June Week 4 2010
Search Details:
[exp Scaphoid Bone OR exp Carpal Bones OR scaphoid$.mp. OR exp Fractures, Bone OR fracture$.mp]
Limit to English language AND humans AND all adult (19 plus years).
AND
[exp Magnetic Resonance Imaging OR magnetic resonance imaging$.mp. OR MRI$.mp. OR MR scan$.mp.]
AND
[exp Tomography, X-Ray Computed OR computed tomography scan$.mp. OR CT scan$.mp]
Limit to English language AND humans AND all adult (19 plus years).
AND
[exp Magnetic Resonance Imaging OR magnetic resonance imaging$.mp. OR MRI$.mp. OR MR scan$.mp.]
AND
[exp Tomography, X-Ray Computed OR computed tomography scan$.mp. OR CT scan$.mp]
Outcome:
Twenty papers were identified in Medline, only one paper was relevant to the three-part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience. Memarsadeghi M. Breitenseher MJ. Schaefer-Prokop C. Weber M. Aldrian S. Gabler C. Prokop M. 2006 Austria | 29 patients (17 male, 12 female), mean age: 34 years old Presented with suspected scaphoid fracture but negative initial radiograph, underwent MR imaging and multidetector CT within 6 days after trauma. |
Diagnostic cohort studies, Prospective |
MRI Accuracy* of detecting All fractures vs cortical fractures (*Test confirmed by follow up radiograph at 6 weeks = 11 scaphoid fracture) | 29/29 vs 6/11 | Small sample size, Publication bias was not mentioned |
| CT Accuracy of detecting All fractures vs cortical fractures | 26/29 vs 11/11 | ||||
| MRI vs MDCT Sensitivity | 100% (CI:75%,100%) vs 73% (CI: 87%,100%) | ||||
| MRI vs MDCT Specificity | 100% (CI: 52%,100%) vs 100% (CI: 48%, 89%) |
Author Commentary:
As this study compares multidetector CT to MRI, other types of CT scan, namely longitudinal or sagittal section, may show different results.
Bottom Line:
MRI is superior to CT scan in detecting scaphoid fractures in patients who experience negative initial radiograph findings. However, more research needs to be done to compare these two diagnostic tools to answer the question.
References:
- Memarsadeghi M. Breitenseher MJ. Schaefer-Prokop C. Weber M. Aldrian S. Gabler C. Prokop M. . Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience.