Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
J Med Imaging Radiat Sci. 2022 Mar;53(1):35-40. doi: 10.1016/j.jmir.2021.10.002. Epub 2021 Nov 18.
The suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures.
Patients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks.
68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified.
CBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.
疑似舟状骨骨折仍是一个诊断难题，过度治疗是一种常见的规避风险策略。横断面成像仍是金标准，推荐 MRI，但由于更容易获得或有限的 MRI 可用性，一些人会使用 CT。本可行性研究的目的是评估锥形束 CT（CBCT）是否可以支持早期诊断或排除舟状骨骨折。
2020 年 3 月至 7 月期间招募了疑似有舟状骨骨折的患者。所有患者均接受了 4 视图 X 射线检查。如果该检查正常，他们将立即转诊接受腕部 CBCT 扫描。如果扫描正常，则将其出院进行 2 周和 6 周的研究随访。
共招募了 68 名参与者，其中 55 名 X 射线检查正常或不确定，并进行了 CBCT 检查。CBCT 显示另外 9 例（16.2%）桡腕关节骨折，其余患者出院进行研究随访。根据 2 周和 6 周的随访，有 3 名患者（4.4%）因持续症状被转诊行 MRI 检查，未发现骨损伤。
CBCT 扫描可快速诊断或排除舟状骨骨折，还可发现其他骨折并有助于早期治疗。快速通道还使那些没有骨损伤的患者能够开始康复，这表明患者可以在接受 CBCT 扫描后安全出院，并提供安全网建议。
