Clinical utility of tomosynthesis in suspected scaphoid fracture: Preliminary results evaluating the VolumeRad technique

Transcription

1 Clinical utility of tomosynthesis in suspected scaphoid fracture: Preliminary results evaluating the VolumeRad technique Poster No.: C-2193 Congress: ECR 2010 Type: Scientific Exhibit Topic: Musculoskeletal Authors: M. Geijer, A. M. Börjesson, J. H. Göthlin ; Lund/SE, Mölndal/ SE, Göteborg/SE Keywords: scaphoid, fracture, tomosynthesis DOI: /ecr2010/C-2193 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose In several studies the reported prevalence of clinically suspected but radiographically not verified (occult) scaphoid fractures ranges between 9% and 33%. A suspected occult scaphoid fracture may be further imaged with repeat radiography, CT, MRI and nuclear medicine modalities. Tomosynthesis is a digital tomographic method using multiple low-dose exposures from a moving X-ray tube directed towards a stationary digital detector. Using the information from the multiple low-dose exposures, up to 60 tomographic sections may be reconstructed. Few case reports in musculoskeletal radiology have been published. The current presentation is the first series reported. The purpose of the present investigation was to evaluate the clinical utility of tomosynthesis in detecting occult scaphoid fractures. Images for this section: Page 2 of 10

3 Fig. 1: Ghost images of the starting and ending positions of the x-ray tube for a chest tomosynthesis scan. Page 3 of 10

4 Methods and Materials Thirty-five patients (16 male and 19 female, median age 23 years) with clinically suspected occult scaphoid fractures were examined with radiography and tomosynthesis (De#nium 8000 with VolumeRAD; GE Healthcare) at the two week follow-up after wrist trauma. Even at review all initial radiography radiographic examinations were negative for scaphoid fracture. At the two-week follow-up a standard repeat four-film scaphoid series was supplemented by a tomosynthesis examination. Sixty low-dose projection images of the wrist with the hand in ulnar deviation were used to reconstruct tomographic sections with 1 mm nominal thickness without overlap. The detector position was #xed, whereas the x-ray tube performed a vertical continuous movement from to around the standard orthogonal postero-anterior position, with the hand in ulnar deviation. All radiographs were reviewed by one senior and one resident radiologist blinded to the information from the tomosynthesis images. At the review all patients had a post-trauma follow-up time of more than one year. Results All primary radiographic examinations were negative for scaphoid fracture. Repeat radiography examination revealed one previously undetected scaphoid tubercle avulsion and one waist fracture, respectively. Tomosynthesis revealed two additional cases of scaphoid waist fracture (2/35, 6%), 11 and 16 days after trauma, respectively. In total, 3 initially occult scaphoid waist fractures were detected (3/35, 9%). Furthermore, the addition of tomosynthesis to radiography increased the diagnostic confidence. Images for this section: Page 4 of 10

5 Fig. 1: A 20-year old male with a suspected scaphoid fracture after a fall on an outstretched hand. Initial radiographs were normal, as are the radiographs (image) at two weeks follow-up. Page 5 of 10

6 Fig. 2: The tomosynthesis scan obtained at the two week follow-up examination. A nondisplaced scaphoid waist fracture is visible at the end of the scan, corresponding to the dorsal cortex. Page 6 of 10

7 Fig. 3: Still image from the tomosynthesis scan at the two week follow up examination. The non-displaced fracture is clearly visible. Page 7 of 10

8 Conclusion Occult scaphoid fractures are fairly common, and the consequences of late detection with ensuing complications may be grave. However, most of the patients with clinically suspected scaphoid fractures actually have no lesion but are subjected to unnecessary treatment. In the current study tomosynthesis diagnosed four scaphoid fractures not seen at primary radiography, two of which were only detected with tomosynthesis and not on concomitant radiography. No false negative or positive diagnosis could be proved. Furthermore, tomosynthesis improved the feeling of diagnostic security. References Beeres FJ, Hogervorst M, den Hollander P, Rhemrev S. Outcome of routine bone scintigraphy in suspected scaphoid fractures. Injury 2005;36(10): Beeres FJ, Hogervorst M, Rhemrev SJ, den Hollander P, Jukema GN. A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. Injury 2007;38(7): Beeres FJ, Rhemrev SJ, den Hollander P et al. Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures. J Bone Joint Surg Br 2008;90(9): Breitenseher MJ, Metz VM, Gilula LA et al. Radiographically occult scaphoid fractures: value of MR imaging in detection. Radiology 1997;203(1): Brismar J. Skeletal scintigraphy of the wrist in suggested scaphoid fracture. Acta Radiol 1988;29: Brooks S, Wluka AE, Stuckey S, Cicuttini F. The management of scaphoid fractures. J Sci Med Sport 2005;8(2): Brydie A, Raby N. Early MRI in the management of clinical scaphoid fracture. Br J Radiol 2003;76(905): Page 8 of 10

9 Fowler C, Sullivan B, Williams LA, McCarthy G, Savage R, Palmer A. A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture. Skeletal Radiol 1998;27(12): Groves AM, Kayani I, Syed R et al. An international survey of hospital practice in the imaging of acute scaphoid trauma. AJR Am J Roentgenol 2006;187(6): Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F. Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography. AJR Am J Roentgenol 2002;178(5): Kusano N, Churei Y, Shiraishi E, Kusano T. Diagnosis of occult carpal scaphoid fracture: a comparison of magnetic resonance imaging and computed tomography techniques. Tech Hand Up Extrem Surg 2002;6(3): Larsen CF, Brondum V, Skov O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand 1992;63(2): Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C et al. Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience. Radiology 2006;240(1): Tiel-van Buul MM, van Beek EJ, Broekhuizen AH, Bakker AJ, Bos KE, van Royen EA. Radiography and scintigraphy of suspected scaphoid fracture. A long-term study in 160 patients. J Bone Joint Surg Br 1993;75(1):61-5. Tiel-van Buul MM, Roolker W, Broekhuizen AH, Van Beek EJ. The diagnostic management of suspected scaphoid fracture. Injury 1997;28(1):1-8. Personal Information Mats Geijer, M.D., Ph.D., Department of Radiology, Skåne University Hospital Lund, S Lund, Sweden Annika M. Börjesson, M.D., Department of Radiology, Sahlgrenska University Hospital, S Mölndal, Sweden Page 9 of 10

10 Jan H. Göthlin, M.D., Ph.D., Department of Radiology, Sahlgrenska University Hospital, S Gothenburg, Sweden Page 10 of 10