Normal Plain Radiographs Research Articles

The utility of ultrasound and plain radiographs in the management of developmental dysplasia of the hip.

The purpose of this study is to assess the utility of follow-up radiological imaging in the management of developmental dysplasia of the hip (DDH) in patients successfully treated with the Pavlik harness. A retrospective review was conducted on all children under 6 months diagnosed with DDH at a tertiary pediatric hospital between January 2004 and December 2018. Inclusion criteria included successful Pavlik harness treatment following a standardized protocol with complete radiological documentation at 2 years of age. Ultrasonography was reviewed to measure the α and β angles and Graf classification. Anteroposterior pelvic radiographs were evaluated for the acetabular index and residual acetabular dysplasia. Seventy-eight hips from 57 infants were included in this study. The mean 6-month, 12-month and 2-year acetabular index of Graf I, IIa and IIc hips on ultrasound at 12 weeks were within the normal range according to age. There were no Graf IIb, IId, III and IV hips. All infants had normal radiographs at 2 years follow-up. The 6- and 12-month residual dysplasia rates in patients with DDH normalization at 12 weeks and 6 months range from 2.5 to 8.82%. Regardless of when the acetabular index normalized, all patients eventually had normal hip radiographs at 2 years of age. Following a standardized protocol, patients undergoing Pavlik harness treatment for DDH with Graf I and IIa hips at 12 weeks are likely to have normal plain radiographs at discharge. The incidence of residual dysplasia is very low and hence, radiographic surveillance is probably unnecessary until discharge at 2 years. Level II, retrospective study.

Role of Magnetic Resonance Imaging in ClinicallyorRadiographically Suspected Patients of Avascular Necrosis of Femoral Head

Background- Present study was conducted to diagnose AVN (avascular necrosis) in patients presenting with complaint of pain hip joint pain and to study role of MRI in patients who are clinically or radiographically suspected cases of avascular necrosis of femoral head. Methodology- This cross-sectional study was conducted on patients referred to the Radio-Diagnosis department with suspicion of AVN. X-ray and MRI hip was done and modified Ficat and Arlet classification was used for staging. Results- About 50 patients had AVN, of which 32 had AVN unilaterally and 32 bilaterally. Out of 29 patients who were at stage 0 in X ray (normal plain radiograph), 3 patients were found be at stage I, 25 patients were found to be at stage II and 1 patient was diagnosed with stage III AVN on MRI. Out of 37 patients with stage 3 AVN on X ray, MRI was also able to confirm stage III in all the 37 patients with additional 3 patients and 1 patient, who were at stage 2 and stage 1 in X ray respectively. Similarly, out of 9 patients diagnosed with stage 4, all were confirmed in stage IV in MRI. Conclusions- As compared to X-ray, MRI has an advantage in terms of being non-invasive, radiation free and ability for detection of earliest changes of femoral head AVN. Majority of patients were diagnosed with early AVN changes where plain radiographs were normal and unable to show any significant changes..

Assessing the relative benefits of imaging with plain radiographs and microCT scanning to diagnose cancer in past populations

ObjectiveTo determine the degree to which plain radiographs (x-rays) and microCT scans can improve accuracy in the diagnosis of cancer in human remains from past populations. MaterialsThe skeletal remains of 143 individuals from medieval Cambridgeshire, dating from 6th–16th century CE. MethodsVisual inspection of the skeletons for lesions compatible with malignancy, coupled with plain radiographs and microCT scans of the pelvis, femora and vertebra. ResultsThree individuals had visually apparent metastases on their skeletons. Plain radiographs did not identify further individuals with cancer, but did show further lesions in bones with normal external appearance. MicroCT scans identified cancer in two further individuals with normal visual appearance and normal plain radiographs. ConclusionsImaging human skeletal remains increases the detection rate of cancer in human skeletal remains. We found microCT scanning to be a much more sensitive imaging modality than plain radiography. It improved our diagnostic accuracy and enabled us to more reliably distinguish between malignant lesions and taphonomic change. SignificanceFuture studies investigating the prevalence and nature of malignancy in past populations would benefit from systematic microCT scanning of pelvis, femora and vertebrae of skeletons to optimise their diagnostic accuracy. LimitationsMicroCT scanning is more expensive than plain radiographs, and may not be easily accessible to biological anthropologists. Suggestions for further researchTo apply this approach to skeletal series from different time periods and geographical regions, where the types of cancer existing in the local population may differ from those we studied in medieval Britain.

Subtle Essex-Lopresti, what the literature teaches us illustrated by 2 case reports.

Subtle Essex-Lopresti Lesion (ELL) is a rare slow onset longitudinal forearm instability that can presents with subnormal initial radiographs and can easily be missed for the inattentive eye. We reviewed the literature about the subtle ELL illustrated by the report of 2 cases with initially isolated radial neck fractures that turned out to be a subtle ELL pattern. The subtle ELL defined by normal or subnormal initial plain radiographs is usually an association of a slight rupture of the 3 longitudinal stability elements of the forearm being a proximal radius fracture, an inter osseous membrane (IOM) rupture and a distal radio ulnar joint dislocation. These subtle alterations that are often missed worsen with time as do their prognosis making it an emergency to diagnose them and treat them as soon as possible. If diagnosis can involve ultrasound and MRI, the most important key is the initial clinical examination and plain radiographs that has both to be repeated in a short period of time. Among the treatment options, for the acute diagnosis, treatment is similar to usual ELL. As for the missed ones, the proximal radius being usually healed with little displacement can be treated with an ulnar osteotomy alone with good results or associated with IOM reconstruction. Subtle ELL is a rare condition but heavy of consequences for the patients that must be known diagnosed and treated as early as possible by upper extremity surgeons even if there is not a consensual treatment which asks for more research about that subject.

Limited benefit of CT scans in tuberculosis contact tracing

ObjectiveThe detection of abnormal findings on computed tomography (CT) scans of tuberculosis contacts combined with normal plain radiographs contributes to the early detection of tuberculosis. However, the benefit of the early detection of abnormalities for the prevention of active tuberculosis during follow-up requires evaluation. MethodWe conducted retrospective comparison of the existence of CT scans of tuberculosis contacts without findings of active tuberculosis on plain radiographs at a hospital in Japan. Results: Among 243 contacts without CT scans, five developed tuberculosis during follow-up. Among 229 contacts with CT scans, 24 were judged as targets of multi-drug therapy since their CT findings were suggestive of active tuberculosis at the time of the CT screening. Among 205 contacts judged as having latent tuberculous infection with CT screening, three developed tuberculosis diseases during follow-up. Conclusion: CT scans detected abnormal findings among contacts without abnormalities of plain radiographs but there were some contacts that developed tuberculosis diseases among those with contact investigation including CT scan. The value of CT is equivocal considering the balance of true treatment, overtreatment and harm of radiation.

Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter?

To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles. In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included. Twelve standardized syndesmosis measurements at two axial planes (10mm above the tibial plafond and 5mm below the talar dome) were obtained by two expert readers using a custom CBCT viewer with the capability for geometric measurements between user-identified anatomical landmarks. Inter-reader reliability between two readers was obtained using the intra-class correlation coefficient (ICC). We compared the WB and NWB measurements using paired t test. Significant agreement was observed between two readers for both WB and NWB measurements (p <0.05). ICC values for WB and NWB measurements had a range of 50-95 and 31-71 respectively. Mean values of the medial clear space on WB images (1.75, 95% confidence interval [95% CI]: 1.6, 1.9) were significantly lower than on NWB images (2.05, 95% CI: 1.8, 2.2) measurements (p <0.001). There was no significant difference between the remaining WB and NWB measurements. Measurements obtained from WB images are reliable. Except for the medial clear space, no significant difference in syndesmotic measurements were observed during the WB mode of CBCT acquisition, implying that the tibio-fibular relationship remains unchanged when the physiological axial weight-bearing load is applied.

Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture

To correlate the physical examination finding of distal radial metaphyseal tenderness with plain radiographic and magnetic resonance imaging after acute wrist injury to diagnose occult distal radius fractures. We hypothesized that persistent distal radial metaphyseal tenderness 2 weeks after acute injuries is predictive of an occult fracture. Twenty-nine adult patients presented, after acute trauma, with distal radial metaphyseal tenderness and initial plain radiographs and/or fluoroscopic images that did not show a distal radius fracture. Patients were reevaluated clinically and radiographically at approximately 2 weeks after initial presentation. Patients with persistent distal radial tenderness and negative radiographs underwent magnetic resonance imaging to definitively diagnose an occult distal radius fracture. We calculated the sensitivity and positive predictive value for persistent distal radial metaphyseal tenderness using a 95% confidence interval and standard formulas. Both radiographs and magnetic resonance imaging were used as our endpoint diagnosis for a distal radius fracture. We diagnosed 28 occult distal radius fractures, 8 by follow-up radiograph and 20 by magnetic resonance imaging. The positive predictive value for patients who completed the protocol was 96%. One patient who did not have an occult distal radius fracture had a fracture of the ulnar styloid. Tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images. Diagnostic III.

What is the best imaging test for patients with suspected scaphoid fractures and normal plain radiographs?

EVIDENCE-BASED ANSWER For a patient with a suspected scaphoid fracture but normal plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy are all reasonable next-step imaging modalities (SOR: A, meta-analysis of cohort studies). From a healthcare spending perspective, CT or MRI may be more cost effective than a strategy of immobilization with follow-up after 2 weeks for repeat plain radiographs and orthopedic consultation (SOR: B, cost-effectiveness analysis).

Radio-Anatomical Study of Bohler’s (Calcaneal) Angle of Southern Nigerians

Introduction: The Bohler’s angle(BA) is the angle between two lines tangent to the calcaneus on the lateral radiograph of an ankle. These lines are drawn tangent to the anterior and posterior aspects of the superior calcaneus.Aim: To establish base line reference data of BA required when surgical realignment of the ankle or radiological diagnosis of ankle mal alignment is required for the subject population establishing possible difference of BA among Nigerian population.Method: A total of 140 normal lateral plain radiographs of the foot and ankles, comprising of 57 male and 83 females between the ages of 10 and 60 years of age were randomly selected to establish normal BA in the study population using standard methods.Results: The mean BA reported for this study was 36.480± 4.950 with a range of 25-360 and a direct proportional relationship between BA and age of the subjects. Female subjects had a mean BA of 36.38±6.02 while their male counterpart had a BA of 36.63±8.42.Discussion: There was no significant gender difference and bilateral asymmetry in reported BA at P&gt;0.05. The range of variation in calcaneal angle have never been reported to exceed 150, while the lowest and highest reported BA has been 250 and 400 respectively, this is similar to finding among population of close similarity.Conclusion: Borhler’s angle of Southern Nigerian do not have a significant difference from those of other Nigerian subjects.

Imaging of occult hip fractures: CT or MRI?

ObjectivesPatients presenting with hip pain but normal plain radiographs may ultimately be shown on further investigation to have suffered an occult hip fracture (OHF). This diagnosis can be made with CT or MRI. Traditionally MRI has been considered a superior modality. We performed a retrospective review of all patients presenting to our service with a suspected OHF over a four-year period, investigated with either CT or MRI. DesignRetrospective review. SettingUrban trauma centre. PatientsPatients with suspected hip fractures and negative radiographs. InterventionCT or MRI. Main outcome measuresDetection rate; delay in request for further imaging; delay to theatre; re-presentations with missed fractures. ResultsA total of 179 patients were investigated, with a mean age of 82±13 years. The ultimate diagnosis was of an OHF in 71 cases and pelvic or acetabular fracture in 34. The average time from presentation plain radiograph to further imaging was 2.0±2.7 days, but was significantly shorter for CT. No patient re-presented with unidentified fractures or other localised hip pathology within a 12-month period. ConclusionsModern imaging technology does not appear to miss clinically significant fractures. As CT is usually more accessible than MRI, the results of our study should encourage surgeons to consider CT as a first line investigation for occult hip fractures. We advocate a high index of suspicion and early imaging referral for elderly patients presenting with non-specific hip pain following a fall.Level 3 Evidence.

Laparoscopic management of complicated foreign body ingestion: a case series.

This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients.

Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures

Background and purpose — Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management. Patients and methods — This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009–2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups. Results — Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002). Interpretation — In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.

Acute longitudinal ligament rupture following acute spinal trauma

The authors present a rare case of anterior longitudinal ligament (ALL) rupture in a 47- year-old gentleman following a bicycle accident. The ALL is a continuous band of a variable thickness that acts as a primary spinal stabiliser. Stress, strain or rupture of the ALL usually occurs as a result of hyperextension, with the primary perpetrator being whiplash injuries. Such injuries have been shown to result in cervical spine instability during extension, axial rotation, and lateral bending modes. Spine radiographs of such patients may be routinely assessed as normal, therefore this specific type of injury does not lend itself to identification by traditional imaging methods. This account demonstrates the importance of having a high index of suspicion of a ligamentous neck injury in the setting of normal plain radiographs but abnormal clinical examination.

ACCURACY OF SPECT IMAGING FOR ARTHROSCOPICALLY CONFIRMED MENISCAL TEARS IN PATIENTS WITH ACUTE KNEE PAIN AND NO RADIOGRAPHIC ARTHRITIS

Purpose: To evaluate the accuracy of single photon emission computed tomography (SPECT) compared with arthroscopy in the diagnosis of acute knee pain due to meniscal tear. Methods: Patients with knee pain that persisted for less than six months with normal plain radiographs that had arthroscopic surgery following SPECT scan were included. The main scintigraphic criterion for diagnosing a tear of the meniscus was tibial plateau activity on the planar image with at least a half crescent of peripheral tibial plateau uptake. The accuracy of SPECT in detecting meniscal tears was calculated according to the arthroscopic findings as the gold standard. Results: There were 68 patients in the study (46 males and 22 females). The mean age was 45.3 (17–72) years and the mean time between SPECT scan and surgery was 3.5 (1–6) months. The overall sensitivity of SPECT was 90%, specificity 70%, NPV 54%, PPV 95% and accuracy 87%. Conclusion: SPECT was found to be an accurate imaging technique in the diagnosis of symptomatic meniscal tears in patients with acute knee pain and unremarkable plain radiographs. Thus, SPECT may be helpful in selecting candidates for arthroscopy.

Lymphoma with unusual manifestations resembling acute osteomyelitis in bilateral ankles of an 8-year-old boy

Early proper diagnosis of non-Hodgkin's lymphoma is critical. However, without a high index of suspicion, the diagnosis can often be missed because of the nonspecific symptoms and normal plain radiographs. Further, non-Hodgkin's lymphoma can be misdiagnosed as an infectious condition - such as osteomyelitis or septic arthritis - or as an inflammatory disease. The authors report a case of mature B-cell lymphoma of the small intestine or colorectal primary malignancy with peritoneal seeding and multiple bone metastases in an 8-year-old boy. This case report emphasizes the importance of a comprehensive approach with patients, including children with nonspecific symptoms, to orthopedic surgeons.

A75: Proposal of the Bristol Criteria for the Diagnosis of Chronic Non‐bacterial Osteitis From a Cohort of 41 Patients

Background/Purpose:Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disease occurring primarily in children and adolescents. Delays in referral and diagnosis may lead to prolonged courses of antibiotics with in‐patient care, substantial radiation exposure from multiple plain radiographs or bone scans and bone biopsies which may be repeated.Methods:Children (aged less than 18 years) diagnosed with CRMO between January 2005 and December 2012, who were reviewed at Bristol Royal Hospital for Children were included; their clinical notes reviewed, laboratory, histopathology and radiology data were extracted. We retrospectively applied the Bristol criteria for diagnosis (table ). Bristol diagnostic criteria for CRMO The presence of typical clinical (a) and radiological findings (b) in more than one bone (or clavicle alone) without significantly raised inflammatory markers OR Typical clinical and radiological findings in one bone plus inflammatory changes (plasma cells, osteoclasts, fibrosis or sclerosis on bone biopsy with no bacterial growth. a Typical clinical findings include bony pain with or without localised swelling. Absence of significant local or systemic features of inflammation or infection. b Typical radiological findings constitute: plain x‐rays showing a combination of lytic areas, sclerosis and new bone formation or preferably STIR MRI showing bone marrow oedema +/− bone expansion, lytic areas and periosteal reaction.Results:Forty one patients (Female: Male ratio 31:10) were diagnosed as CRMO and assessed at the Bristol centre over the 8 year period. The onset of symptoms occurred at a median of 9 years with a delay in diagnosis with a median of 15 months (range 0–92). Initial plain radiograph was abnormal in 28 out of 36 patients; whole body MRI (WB‐MRI) detected lesions in seven of the patients with normal plain radiograph. 162 lesions were identified by imaging, of which, 47 were asymptomatic and detected only by MRI. After imaging, only ten patients (24%) had a solitary lesion (six of which were clavicle alone). From the data, diagnostic criteria were developed. Using the proposed criteria retrospectively, thirty‐four children could have potentially been diagnosed by criterion 1, with 6 children requiring a biopsy (criterion 2) for diagnosis, either for a solitary lesion not clavicle or atypical features such as age. Bone biopsies in our cohort had been repeated in a third of patients prior to referral. Thirteen children completed at least one year of pamidronate treatment with MRI available both before and after treatment on eleven of these. After a year of pamidronate therapy, 71% of lesions improved and 29 % remained stable on MRI scans. Around 20%–30% patients having pamidronate therapy will continue to have troublesome symptoms.Conclusion:We suggest that using the Bristol diagnostic criteria (table ) with an experienced clinician may obviate the need for biopsy in some patients. Pamidronate was found to be a useful second‐line agent with objective MRI evidence of benefit.

Residual Symptoms of Occult Pediatric Ankle Injuries: MRI-Diagnosed Bone Bruising

Aims: To define the nature of non-radiographically evident injuries of the ankle and hindfoot in children who exhibited persistent pain, swelling and refusal to bear weight after 6 weeks of immobilisation. Methods: Ten children (7 boys, 3 girls; age range 5 to10 years) were included in the study. They presented with normal plain radiographs after an acute traumatic ankle injury. They were all immobilised for 6 weeks. The detection of residual symptoms and signs indicated the need of a limited magnetic resonance imaging (MRI). It revealed bone bruising localized to the hindfoot in all cases. Bone bruises were classified according to anatomical location and whether they were solitary lesions or were combined with other soft tissue injuries. Results: From a total of 10 cases, 6 were unifocal, 3 of them were localized to the talus and 3 to the calcaneus, while in 4 multifocal cases bone bruising involved all the bones of the hindfoot. All cases were associated with a varying degree of soft tissue injuries including signs of ankle and subtalar joint effusion, but there was no evidence of ligamentous injuries in our patients. The total period of immobilisation reached 3 months for unifocal bone bruises and 4 months for multifocal lesions. In all cases, a prolonged recovery period exceeding 2 months followed before return to normal activities including sports. The long-term follow-up ranged from 2 to 5 years. No complications were detected. Conclusion: A limited MRI examination is indicated in children with residual symptoms following acute ankle injuries. Bone bruising localized to the hindfoot was the “occult” Case Study British Journal of Medicine & Medical Research, 4(1): 295-303, 2014 296 bone lesion diagnosed in all our cases. This study indicates that bone bruising or contusion should be classified as a distinct clinical entity best visualized on MRI with fat suppression.

Acute Myeloid Leukemia Presenting as Back Pain in a 12-Year-Old Boy

Acute Myeloid Leukemia Presenting as Back Pain in a 12-Year-Old Boy

Role of SPECT/CT Compared With MRI in the Diagnosis and Management of Patients With Wrist Trauma Occult Fractures

The diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of nonunion risk. Currently, new hybrid technologies are emerging such as 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. In this study, all patients addressed at the orthopedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs were prospectively included. Patients with normal radiographs but with signs strongly suggestive 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 up for at least 6 months and reviewed by the same surgeon. SPECT/CT findings were compared with those of the other modalities and follow-up. From December 2009 to May 2011, 57 patients were enrolled. Fifty-seven SPECT/CT and 52 MRI scans were obtained. Twenty-eight patients had normal imaging results, whereas 29 patients presented bone bruise and/or fractures. Ten patients were concordant according to SPECT/CT and MRI; 2 patients presented fractures on SPECT/CT without MRI performed; 17 patients had partially discordant results. Only 1 patient presented a nonunion at the follow-up, whereas both investigations were positive. This study highlights the good performances of SPECT/CT, which allows the detection of most occult carpal fractures. When a carpal occult fracture is strongly suspected clinically, SPECT/CT might be proposed at first intention after normal radiographs.

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

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.