title: Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in  patients with clinical scaphoid fracture: an imaging study.
abstract: BACKGROUND
  Although magnetic resonance imaging (MRI) is now considered the gold standard in second-line imaging of patients with suspected scaphoid fracture and negative radiographs, bone scintigraphy can be used in patients with pacemakers, metallic implants, or other contraindications to MRI. Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy.
  
  
  OBJECTIVE
  To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation in patients with suspected scaphoid fracture.
  
  
  METHODS
  In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case.
  
  
  RESULTS
  The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive interpretations of two of the observers from 11 and nine cases to six and seven cases, respectively. The degree of diagnostic confidence increased significantly in two observers, and interobserver agreement increased in all three pairs of observers from 0.83, 0.57, and 0.73 to 0.89, 0.8, and 0.9, respectively.
  
  
  CONCLUSIONS
  Image fusion of planar bone scintigrams and radiographs has a significant influence on image interpretation and increases both diagnostic confidence and interobserver agreement.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, Glostrup, Denmark. otthen01@glo.regionh.dk
authors.forename: O M
authors.initials: OM
authors.lastname: Henriksen
authors.forename: M N
authors.initials: MN
authors.lastname: Lonsdale
authors.forename: T D
authors.initials: TD
authors.lastname: Jensen
authors.forename: K L
authors.initials: KL
authors.lastname: Weikop
authors.forename: O
authors.initials: O
authors.lastname: Holm
authors.forename: B
authors.initials: B
authors.lastname: Duus
authors.forename: L
authors.initials: L
authors.lastname: Friberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D018709:Statistics, Nonparametric; D013669:Technetium Tc 99m Medronate
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate