Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations.

ABSTRACT

PURPOSE: The aim of this prospective study was to evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) in detecting occult scaphoid fractures. MATERIALS AND METHODS: A total of 54 patients with a clinically suspected scaphoid fracture and negative initial conventional radiographs were evaluated with 64-row MDCT wrist examinations within 1 week of the trauma. The gold standard used was the diagnosis on MRI done within 1 week after MDCT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT were calculated. RESULTS: MRI showed a total of 22 fractures in 20 of 55 (36%) wrists. Fractures included 14 scaphoid and 8 other carpal bones. MDCT showed a total of 19 fractures in 17 of 55 (30%) wrists. Two isolated scaphoid fractures and one trapezium fracture were missed on MDCT. The sensitivity, specificity, PPV, and NPV of MDCT were 86%, 100%, 100%, and 91%, respectively. CONCLUSION: MDCT offers highly accurate results, especially concerning cortical involvement, and is a useful alternative in facilities lacking MRI.