title: Comparison of MRI, CT and bone scintigraphy for suspected scaphoid fractures.
abstract: OBJECTIVE
  The best diagnostic modality for confirmation of the diagnosis of a scaphoid fracture that is not visible on the initial radiograph (occult scaphoid fracture) is still subject of debate. The aim of this study was to compare the accuracy of magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy (BS) for the diagnosis of these occult scaphoid fractures.
  
  
  METHODS
  In a study period of 12 months, 33 consecutive patients with a clinically suspected scaphoid fracture without a fracture on the scaphoid radiographs were evaluated with MRI, CT and BS. In case of a discrepancy between the diagnostic modalities, the final diagnosis was based on standardised follow-up with clinical examination and a repeated radiograph.
  
  
  RESULTS
  Three of the 33 patients had a scaphoid fracture. MRI missed one scaphoid fracture and did not over-diagnose. CT missed two scaphoid fractures and did not over-diagnose. BS missed no scaphoid fractures and over-diagnosed one scaphoid fracture in a patient with a fracture of the trapezium.
  
  
  CONCLUSIONS
  This study shows that neither MRI, nor CT and BS are 100 % accurate in diagnosing occult scaphoid fractures. MRI and CT miss fractures, and BS tends to over-diagnose. The specific advantages and limitations of each diagnostic modality should be familiar to the treating physicians and taken into consideration during the diagnostic process.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Postbus 9600, 2300 RC, Leiden, The Netherlands. p.krijnen@lumc.nl.|Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands. p.krijnen@lumc.nl.
authors.forename: A D
authors.initials: AD
authors.lastname: de Zwart
authors.affiliation: Deparment of Surgery, Luzerner Kantonsspital, 6006, Lucerne, Switzerland.
authors.forename: F J P
authors.initials: FJ
authors.lastname: Beeres
authors.affiliation: Department of Surgery, Medical Centre Haaglanden, 2512 VA, The Hague, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhemrev
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Postbus 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Bartlema
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Postbus 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate
keywords: Bone scintigraphy; CT; MRI; Scaphoid fracture