Schmitt R, Rosenthal H
Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale, Germany.
Diagnostic and Interventional Radiology, KRH Hospital Siloah-Oststadt-Heidehaus, Hannover, Germany.
Rofo. 2016 May;188(5):459-69. doi: 10.1055/s-0042-104660. Epub 2016 Apr 13.
Up to 30 % of acute scaphoid fractures are missed in conventional radiography. CT and MRI should be early performed in the diagnostic workflow, when radiograms (dorsopalmar, lateral and Stecher's views) are negative or inconclusive in fracture detection. Significance of CT is different from that of MRI: Sensitivity of CT imaging (85 to 95 %) is superior to conventional radiography (about 70 %), but inferior to MRI (almost 100 %). However, CT (specificity 95 to 100 %) is able to provide more detailed anatomic information of the fracture pattern when compared to MRI (specificity 80 to 90 %). Particularly, differentiation of bone contusion ("bone bruise") and non-displaced fracture can be difficult in MRI. Thus, CT indication is not only given for fracture detection, but also for assessing the morphology in scaphoid fractures (localization, fragment dislocation, comminuted zones) and the fragment instability, too. MRI should be limited to equivocal trauma cases presenting pain in the snuff box, but with inconclusive CT findings. In CT and MRI of scaphoid fractures, image display must be aligned along the longitudinal extension of the scaphoid, either by acquiring or reformatting oblique-sagittal and oblique-coronal planes. Key points • Radiography can be limited to the dorsopalmar, lateral and Stecher's views in scaphoid fractures.• In CT and MR imaging, the dedicated anatomy of the scaphoid has to be covered with oblique-sagittal and oblique-coronal images.• CT provides most detailed information of scaphoid fractures (localization, fragment dislocation and instability pattern). However, its capability in detecting non-displaced fractures is inferior to MRI.• All scaphoid fractures are seen in MRI. But differentiation of bone contusion (bone bruise) and a non-displaced fracture can be crucial.• This order is recommended in the diagnostic algorithm of scaphoid fractures: 1. radiography, 2. CT, and 3. MRI. Citation Format: • Schmitt R, Rosenthal H. Imaging of Scaphoid Fractures According to the New S3 Guidelines. Fortschr Röntgenstr 2016; 188: 459 - 469.
在传统X线摄影中，高达30%的急性舟骨骨折会被漏诊。当X线片（正位、侧位和Stecher位）在骨折检测中为阴性或不确定时，应在诊断流程中尽早进行CT和MRI检查。CT和MRI的意义不同：CT成像的敏感性（85%至95%）优于传统X线摄影（约70%），但低于MRI（几乎100%）。然而，与MRI（特异性80%至90%）相比，CT（特异性95%至100%）能够提供更详细的骨折形态解剖信息。特别是，在MRI中区分骨挫伤（“骨挫伤”）和无移位骨折可能很困难。因此，CT不仅用于骨折检测，还用于评估舟骨骨折的形态（定位、骨折块移位、粉碎区域）以及骨折块的稳定性。MRI应限于在鼻烟壶处有疼痛但CT结果不确定的可疑创伤病例。在舟骨骨折的CT和MRI检查中，图像显示必须沿舟骨的纵向延伸方向进行对齐，可通过采集或重新格式化斜矢状面和斜冠状面来实现。要点 • 舟骨骨折的X线摄影可限于正位、侧位和Stecher位。• 在CT和MR成像中，舟骨的特定解剖结构必须用斜矢状面和斜冠状面图像覆盖。• CT提供舟骨骨折最详细的信息（定位、骨折块移位和不稳定模式）。然而，其检测无移位骨折的能力不如MRI。• MRI能显示所有舟骨骨折。但区分骨挫伤（骨挫伤）和无移位骨折可能至关重要。• 推荐在舟骨骨折的诊断算法中采用以下顺序：1. X线摄影，2. CT，3. MRI。引用格式：• Schmitt R, Rosenthal H. Imaging of Scaphoid Fractures According to the New S3 Guidelines. Fortschr Röntgenstr 2016; 188: 459 - 469.
