title: Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures.
abstract: OBJECTIVE
  To compare diagnostic accuracy and interobserver reliability of Magnetic Resonance Imaging (MRI) and Multidetector Computed Tomography (MDCT) in the detection of acute pelvic fractures.
  
  
  METHODS
  In 38 consecutive patients (mean age 74.7 years) with a positive finding of anterior pelvis fracture in the conventional X-rays, pelvic MRI and MDCT were performed for further evaluation of pelvic ring fractures. Two radiologists independently read all data sets. Sensitivity and specificity were calculated based on mean scores for each method. Sensitivities of CT and MRI were compared using a paired proportion test (McNemar). Diagnostic validity of both methods was assessed by the interobserver variability using kappa statistics. Combined clinical data and findings from all imaging studies served as the reference standard.
  
  
  RESULTS
  122 fractures were identified in the reference standard (37 sacral, 58 pubic, 22 acetabular, 1 ischial, 4 ilial). On average, MRI detected 96.3% whereas CT detected 77% of all fractures. With regard to sensitivity, MRI proved to be significantly better compared to MDCT (observer 1, p=0.0009; observer 2, p=0.0003 by observer 2). In particular, MRI performed better in the depiction of sacral fractures, reaching a sensitivity of 98.6% compared to 66.1% at CT. The interobserver variability was determined to be very good (k=0.955 for MRI and 0.902 for MDCT).
  
  
  CONCLUSIONS
  MRI reaches a significantly higher sensitivity than CT in the detection of acute pelvic fractures, particularly of the sacrum. Especially in elderly patients with suspicion of a sacral fracture and negative results at MDCT, MRI may be considered as the next step in diagnostic workup.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. fhenes@uke.de
authors.forename: F O
authors.initials: FO
authors.lastname: Henes
authors.forename: J V
authors.initials: JV
authors.lastname: Nüchtern
authors.forename: M
authors.initials: M
authors.lastname: Groth
authors.forename: C R
authors.initials: CR
authors.lastname: Habermann
authors.forename: M
authors.initials: M
authors.lastname: Regier
authors.forename: J M
authors.initials: JM
authors.lastname: Rueger
authors.forename: G
authors.initials: G
authors.lastname: Adam
authors.forename: L G
authors.initials: LG
authors.lastname: Großterlinden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult