title: Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures.
abstract: BACKGROUND
  The diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of nonunion risk. Currently, new hybrid technologies are emerging such as SPECT/CT systems, which combine functional and anatomical data sets. So, we wanted to evaluate the utility of SPECT/CT in the management of occult carpal fractures.
  
  
  METHODS
  In this study, all patients addressed at the orthopedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs were prospectively included. Patients with normal radiographs but with signs strongly suggestive of clinical fracture underwent a bone SPECT/CT and an MRI of the wrist. Therapeutic management took into account the results of all modalities, and all patients were followed up for at least 6 months and reviewed by the same surgeon. SPECT/CT findings were compared with those of the other modalities and follow-up.
  
  
  RESULTS
  From December 2009 to May 2011, 57 patients were enrolled. Fifty-seven SPECT/CT and 52 MRI scans were obtained. Twenty-eight patients had normal imaging results, whereas 29 patients presented bone bruise and/or fractures. Ten patients were concordant according to SPECT/CT and MRI; 2 patients presented fractures on SPECT/CT without MRI performed; 17 patients had partially discordant results. Only 1 patient presented a nonunion at the follow-up, whereas both investigations were positive.
  
  
  CONCLUSIONS
  This study highlights the good performances of SPECT/CT, which allows the detection of most occult carpal fractures. When a carpal occult fracture is strongly suspected clinically, SPECT/CT might be proposed at first intention after normal radiographs.
authors.affiliation: From the *Nuclear Medicine Department, dagger;Orthopaedics Department, and Dagger;Radiology Department, University Hospital; sect;European University of Brittany; and para;University Hospital of Brest, INSERM CIC 05-02, IFR148, Brest, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Querellou
authors.forename: Laetitia
authors.initials: L
authors.lastname: Arnaud
authors.forename: Thomas
authors.initials: T
authors.lastname: Williams
authors.forename: Sylvain
authors.initials: S
authors.lastname: Breton
authors.forename: Danielle
authors.initials: D
authors.lastname: Colin
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Le Roux
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.forename: Alexandra
authors.initials: A
authors.lastname: Le Duc-Pennec
authors.forename: Ronan
authors.initials: R
authors.lastname: Bouttier
authors.forename: Ronan
authors.initials: R
authors.lastname: Abgral
authors.forename: Philippe
authors.initials: P
authors.lastname: Guillo
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Nen
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Salaun
mesh_terms: D000293:Adolescent; D000328:Adult; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015588:Observer Variation; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult