Behzadi C, Karul M, Henes FO, Laqmani A, Catala-Lehnen P, Lehmann W, Nagel HD, Adam G, Regier M. Comparison of conventional radiography and MDCT in suspected scaphoid fractures. World J Radiol 2015; 7(1): 22-27 [PMID: 25628802 DOI: 10.4329/wjr.v7.i1.22]
Corresponding Author of This Article
Cyrus Behzadi, MD, Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. c.behzadi@uke.de
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Jan 28, 2015; 7(1): 22-27 Published online Jan 28, 2015. doi: 10.4329/wjr.v7.i1.22
Comparison of conventional radiography and MDCT in suspected scaphoid fractures
Cyrus Behzadi, Murat Karul, Frank Oliver Henes, Azien Laqmani, Philipp Catala-Lehnen, Wolfgang Lehmann, Hans-Dieter Nagel, Gerhard Adam, Marc Regier
Cyrus Behzadi, Murat Karul, Frank Oliver Henes, Azien Laqmani, Gerhard Adam, Marc Regier, Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Philipp Catala-Lehnen, Wolfgang Lehmann, Department of Hand-, Trauma-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Hans-Dieter Nagel, Science and Technology for Radiology, 21244 Buchholz, Germany
Author contributions: Behzadi C and Karul M collected and analyzed the data equally; Henes FO and Laqmani A provided analytical oversight; Lehmann W and Catala-Lehnen P revised the manuscript; Adam G and Regier M designed and supervised the study; Nagel HD provided technical support, dose calculation and statistical analysis; all authors had taken part in literature research and manuscript preparation and had read and approved the final version.
Ethics approval: The study was reviewed and approved by the local ethics committee (WF-061/13).
Informed consent: Due to the retrospective study design exclusively involving data sets from past examinations taken from the local PACS system, no written informed consent was assessable.
Conflict-of-interest: None of the authors has to declare any conflict of interest in the presented study.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at c.behzadi@uke.de. Informed consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cyrus Behzadi, MD, Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. c.behzadi@uke.de
Telephone: +49-40-741054029 Fax: +49-40-741053802
Received: September 24, 2014 Peer-review started: September 24, 2014 First decision: November 19, 2014 Revised: November 28, 2014 Accepted: December 29, 2014 Article in press: December 31, 2014 Published online: January 28, 2015 Processing time: 111 Days and 15.4 Hours
Abstract
AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures.
METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.
RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid fracture detection. The mean effective dose of MDCT was 0.1 mSv compared to 0.002 mSv of conventional radiography.
CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.
Core tip: Correct diagnosis of acute wrist trauma with suspected scaphoid fractures is a challenging topic in every emergency department. Based on our data, conventional radiography has to be considered as insufficient for accurate scaphoid fracture detection. Regarding the high diagnostic accuracy and low effective dose of multidetector computed tomography, it should be implemented as the imaging modality of first choice in suspected fractures of the scaphoid.
