MAGNETIC-RESONANCE-IMAGING VERSUS BONE-SCINTIGRAPHY IN SUSPECTED SCAPHOID FRACTURE

Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascula rity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone s cintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiogr aphs, We evaluated MRI in this patient group, The bone scan was used a s the reference method. Nineteen patients were included. Bone scintigr aphy was performed in all 19 patients, but MRI could be obtained in on ly 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid f racture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surg ery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid f racture was retrospectively proven on the initial X-ray series, In ano ther two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative, We conclude that in the diagn ostic management of patients with suspected scaphoid fracture and nega tive initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy.