title: Short MRI Protocol for Excluding Traumatic Lesions of the Scaphoid Bone in Children.
abstract: OBJECTIVE
  Management of scaphoid trauma includes imaging with repeated X-rays whose interpretation is difficult and often ambivalent. The aim of the study was to propose a fast magnetic resonance imaging (MRI) protocol permitting exclusion of traumatic lesions of the scaphoid bone in children, which would avoid unnecessary immobilization and irradiation in negative cases.
  
  
  METHODS
  Two pediatric radiologists retrospectively reviewed the X-rays and MRIs of 45 children with clinical suspicion of scaphoid trauma. X-Rays and MRI sequences [short tau inversion recovery (STIR), T1] were scored as: 0 (negative) or 1 (equivocal or positive). X-ray results were compared to those of MRI and interobserver reliability was measured for both methods.
  
  
  RESULTS
  MRI was shown to be more reliable than X-ray in excluding pediatric traumatic scaphoid lesions. X-Ray results differed significantly between the two readers (p=0.0001), and the interobserver reliability was low (κ=0.529). For MRI interpretation, there was no significant difference between the two readers' assessments. The interobserver reliability was high (κ=0.9544) and only in one case was there discordance. Absence of scaphoid trauma was confirmed on MRI in 18 out of 45 patients. For these patients, immobilization was reconsidered and no follow-up X-ray was performed.
  
  
  CONCLUSIONS
  Early MRI is useful in the management of pediatric scaphoid trauma. A short MRI protocol consisting of a STIR and a T1 sequence is sufficient for differentiating positive from negative cases and gives a good negative predictive value for exclusion of a traumatic scaphoid lesion.
authors.affiliation: Department of Pediatric Radiology, Geneva University Children's Hospital, Geneva, Switzerland katerinakan@yahoo.gr.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Kanavaki
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Fribourg, Fribourg, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Draenert
authors.affiliation: Department of Pediatric Orthopedics, Geneva University Children's Hospital, Geneva, Switzerland.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Ceroni
authors.affiliation: Department of Pediatric Radiology, Geneva University Children's Hospital, Geneva, Switzerland.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: Scaphoid bone; bone fracture; children; diagnosis; magnetic resonance imaging