Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis.
Imaging protocols for suspected scaphoid fractures among investigators and hospitals are markedly inconsistent. We performed a systematic review and meta-analysis to assess and compare the diagnostic performance of bone scintigraphy, MRI, and CT for diagnosing suspected scaphoid fractures. Twenty-six studies were included. Sensitivity, specificity, and diagnostic odds ratio were pooled separately and summary receiver operating characteristic curves were fitted for each modality. Meta-regression analyses were performed to compare these modalities. We obtained likelihood ratios derived from the pooled sensitivity and specificity and, using Bayes' theorem, calculated the posttest probability by application of the tests. The pooled sensitivity, specificity, natural logarithm of the diagnostic odds ratio, and the positive and negative likelihood ratios were, respectively, 97%, 89%, 4.78, 8.82, and 0.03 for bone scintigraphy; 96%, 99%, 6.60, 96, and 0.04 for MRI; and 93%, 99%, 6.11, 93, and 0.07 for CT. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. We believe additional studies are needed to assess diagnostic performance of CT, especially paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy.


METHODS
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Yin
Zhong-Gang
ZG
Department of Hand and Microsurgery, Tianjin Hospital, 300211 Tianjin, China. zgyin@hotmail.com
Zhang
Jian-Bing
JB
Kan
Shi-Lian
SL
Wang
Xiao-Gang
XG
D016206:Databases, Bibliographic; D003952:Diagnostic Imaging / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014955:Wrist Joint / Q000000981:diagnostic imaging