Memarsadeghi Mazda, Breitenseher Martin J, Schaefer-Prokop Cornelia, Weber Michael, Aldrian Silke, Gäbler Christian, Prokop Mathias
Department of Radiology, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Radiology. 2006 Jul;240(1):169-76. doi: 10.1148/radiol.2401050412.
To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard.
The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients (17 male, 12 female; age range, 17-62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement (P < .05).
The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only three [corrected] cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures (P = .25) but were significant for cortical involvement (P = .03).
Multidetector CT is highly accurate in depicting occult cortical scaphoid fractures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement.
比较多排螺旋计算机断层扫描（CT）和磁共振（MR）成像对临床怀疑有舟骨骨折且初始X线片正常的患者的诊断性能，以创伤后6周获得的X线片作为参考标准。
伦理委员会批准了本研究，所有患者均签署了书面知情同意书。29例患者（男17例，女12例；年龄范围17 - 62岁；平均年龄34岁±13岁）在创伤后6天内接受了多排螺旋CT和MR成像检查。CT数据采用0.5毫米准直获取。为进行图像分析，在相对于腕部的横断、冠状和矢状平面上进行了0.7毫米厚的多平面重建。1.0-T MR检查包括冠状和横断的短反转时间反转恢复序列、冠状和横断的T1加权自旋回波序列以及冠状容积再现T2加权梯度回波序列。两名放射科医生分析了CT和MR图像。采用二项式检验评估MR成像和CT在检测舟骨骨折及皮质受累方面差异的显著性（P < 0.05）。
6周随访X线片显示11例（38%）患者有舟骨骨折。8例患者为皮质骨折，3例患者仅在舟骨小梁部分有带状透亮区。MR成像显示了所有11例骨折，但仅显示了3例[校正后]皮质骨折。多排螺旋CT显示了所有8例皮质骨折，但未显示小梁骨折。MR或CT图像上均未发现假阳性骨折。MR成像和CT在检测舟骨骨折方面差异不显著（P = 0.25），但在皮质受累方面差异显著（P = 0.03）。
多排螺旋CT在显示隐匿性舟骨皮质骨折方面高度准确，但在仅显示小梁损伤方面似乎不如MR成像。MR成像在显示皮质受累方面不如多排螺旋CT。
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