Performances de la scintigraphie osseuse TEMP/TDM en comparaison avec l’IRM dans le diagnostic des fractures occultes du carpe

Abstract

BackgroundThe diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of non-union risk. Currently new hybrid technologies are emerging such as single photon emission computed tomography–computed tomography (SPECT/CT) systems, which combine functional and anatomical data sets. So, we wanted to evaluate the utility of SPECT/CT in the management of occult carpal fractures. Patients and methodsAll patients addressed to the orthopaedic department at Brest University Hospital for wrist pain after trauma and with initial normal plain radiographs were prospectively included. Patients with normal radiographs but a strong suspicion of clinical fracture underwent a bone SPECT/CT and an MRI of the wrist. Therapeutic management took into account the results of all modalities and all patients were followed for at least 6 months and reviewed by the same surgeon. SPECT/CT findings were compared to those of the other modalities and follow-up. ResultsFrom December 2009 to May 2011, 57 patients were enrolled. Fifty-seven SPECT/CT and 52 MRI were performed. Twenty-six patients presented a positive SPECT/CT (31 fractures). MRI concluded to abnormalities for 26 patients (20 fractures and 17 bone bruises). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy per patient were respectively 88.46%, 96.15%, 95.83%, 89.29%, 92.3% and per lesion 75.68%, 96.15%, 96.55%, 73.53%, 84.13%. Interobserver reproducibility for SPECT/CT was excellent. Only one patient presented a non-union at the follow-up whereas both investigations were positive. ConclusionThis study highlights the good performances of SPECT/CT, which allows the detection of most occult carpal fractures. When a carpal occult fracture is clinically strongly suspected, SPECT/CT might be proposed in first intention after normal radiographs.