高分辨率外周定量 CT 检测与常规 CT 相比可提高舟状骨骨折的检出率。

Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT.

机构信息

Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.

NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.

出版信息

J Bone Joint Surg Am. 2020 Dec 16;102(24):2138-2145. doi: 10.2106/JBJS.20.00124.

DOI:10.2106/JBJS.20.00124

PMID:33079896

Abstract

BACKGROUND

Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting.

METHODS

The present study included 91 consecutive patients (≥18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation).

RESULTS

The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001).

CONCLUSIONS

In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substantial proportion of fractures-in this study, more than one-third-will be missed by the current application of CT scanning in patients with a clinically suspected scaphoid fracture.

LEVEL OF EVIDENCE

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

计算机断层扫描（CT）、磁共振成像（MRI）和骨闪烁扫描是常用于评估临床疑似舟状骨骨折患者的二线影像学技术。然而，由于诊断性能结果的差异，目前尚无真正的舟状骨骨折诊断参考标准。我们假设在临床疑似舟状骨骨折患者中使用高分辨率外周定量 CT（HR-pQCT）可提高 CT 对舟状骨骨折的检测能力。

方法

本研究纳入了 2017 年 12 月至 2018 年 10 月期间因临床疑似舟状骨骨折而就诊于急诊科的 91 例连续患者（≥18 岁）。所有患者在首次就诊后 14 天内进行临床再评估，随后进行 CT 和 HR-pQCT 检查。如果存在舟状骨骨折，根据 Herbert 分类系统确定骨折类型，并使用 Kendall W 统计量或一致性系数（W）（越接近 1，相关性越高）来估计 CT 和 HR-pQCT 之间的相关性。

结果

队列包括 45 名男性和 46 名女性，中位年龄为 52 岁（四分位间距 29 岁至 67 岁）。HR-pQCT 显示 24 例（26%）患者存在舟状骨骨折，而 CT 显示 15 例（16%）患者存在舟状骨骨折。有舟状骨骨折的患者更年轻且更多为男性。根据 Herbert 分类系统，CT 和 HR-pQCT 对舟状骨骨折类型的相关性较高（W = 0.793；95%置信区间 [CI]，0.57 至 0.91；p < 0.001），对舟状骨骨折位置的相关性非常高（W = 0.955；95%CI，0.90 至 0.98；p < 0.001）。