Abstract
We aimed to determine whether bone marrow edema (BME) in acute traumatic scaphoid fracture could be demonstrated with dual-energy CT (DECT) using MRI as the gold standard. In recent years, virtual non-calcium (VNCa) images have been used to demonstrate BME in trauma cases, for example, in vertebral compression fractures, hip trauma to detect occult fractures and knee fractures. We present three cases of acute scaphoid trauma. Two patients had subtle or invisible fractures on x-ray and conventional CT images, while DECT VNCa images clearly visualized the BME, which was confirmed by MRI. One patient had negative findings on both VNCa and MRI images. The DECT VNCa algorithm is a promising technique to demonstrate BME in scaphoid fractures, with potential for increasing the diagnostic value of CT in this type of injury.
Highlights
Diagnosis of scaphoid fracture is often based on the history, clinical findings and radiography
We present the first case series reporting the use of DECTVNCa images in acute scaphoid fracture
dual-energy CT (DECT)-virtual non-calcium (VNCa) images clearly demonstrated bone marrow edema (BME), which was confirmed with MRI
Summary
Diagnosis of scaphoid fracture is often based on the history, clinical findings and radiography. Displacement of more than 1 mm is considered a surgical indication [2], as there is a four-fold increased risk of non-union if these patients are immobilized in a cast compared with non-displaced immobilized fractures [3] Concerns about complications such as non-union or osteonecrosis related to scaphoid fracture have led to the common practice of early immobilization and control with radiography within 7–10 days. A meta-analysis by Carpenter et al compared pooled sensitivity, specificity, and positive and negative likelihood ratios of clinical tests and different imaging modalities [1]. They found clinical tests such as snuffbox tenderness to have a good sensitivity (95%), but low specificity (39%).
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