Commentary on an article by Wouter Mallee, MSc, et al.: “Comparison of CT and MRI for Diagnosis of Suspected Scaphoid Fractures”

Abstract

Despite extensive study, the optimal imaging modality for the diagnosis of a suspected scaphoid fracture remains controversial. Traditionally, patients with clinical findings consistent with scaphoid fracture but with negative initial radiographs have been managed with splint or cast immobilization followed by repeat clinical and radiographic examination two weeks following injury. However, given the relatively low prevalence of true fractures in this population, the classical approach has been criticized for overtreating a majority of these patients. To avoid diagnostic delay and unnecessary immobilization, advanced imaging techniques have gained popularity to facilitate early definitive diagnosis of scaphoid fractures. Studies advocating the use of magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, and ultrasound in the evaluation of suspected scaphoid fractures are plentiful. Among these imaging modalities, MRI has emerged as a relative gold standard, due to both its excellent reported diagnostic performance as well as its ability to identify alternate causes of wrist pain. Criticisms of MRI have been that it is susceptible to misinterpretation of injuries such as bone bruises, potentially resulting in false positive results, and that it has limited capacity to demonstrate subtle degrees of fracture displacement. The use of CT in the acute diagnosis of scaphoid fractures is less well documented but has been advocated because of its lower costs and widespread availability, although the diagnostic accuracy of CT in this situation has been questioned1. Although current institutional protocols vary, an often recommended algorithm is to first proceed …