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Acute Wrist Trauma: Value of a Short Dedicated Extremity MR Imaging Examination in Prediction of Need for Treatment¹

¹ From the Program for the Assessment of Radiological Technology (ART Program), Departments of Radiology (J.J.N., E.H.G.O., A.Z.G., G.P.K., M.G.M.H.), Epidemiology and Biostatistics (J.J.N., E.H.G.O., M.G.M.H.), Orthopaedic Surgery (J.A.N.V.), and Traumatologic Surgery (A.B.v.V.), Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. Received July 8, 2003; revision requested September 24; revision received April 5, 2004; accepted May 19. Supported in part by the Revolving Fund from Erasmus University Medical Center Rotterdam and by an unrestricted grant from Esaote, Genoa, Italy. Address correspondence to M.G.M.H. (e-mail: m.hunink@erasmusmc.nl).

PURPOSE: To assess predictive value of a short magnetic resonance (MR) imaging examination in addition to or instead of radiography in patients with acute wrist trauma to identify patients who require additional treatment versus those who do not and can be discharged without further follow-up.

MATERIALS AND METHODS: Informed consent was obtained from all participating patients; the institutional review board approved the randomized controlled trial and use of data to create prediction models. Of 90 patients (37 female, 53 male; mean age, 40.0 years), 87 with acute wrist trauma were randomized to undergo radiography (n = 43) or radiography and a short MR imaging examination with low-field-strength dedicated extremity MR system (n = 44). Age, sex, trauma mechanism, presence of tenderness of the anatomic snuffbox, radiographic results, MR imaging results, and treatment data were collected. Univariable and multivariable logistic regression analysis was used to create four models for prediction of treatment need.

RESULTS: Thirty-six patients had one or more fractures; one patient had a marked soft-tissue lesion. In univariable analysis, age (odds ratio, 1.02; 95% confidence interval: 1.00, 1.05), anatomic snuffbox tenderness (odds ratio, 2.31; 95% confidence interval: 0.90, 5.96), radiographic results (odds ratio, 31.2; 95% confidence interval: 8.90, 109), and positive MR imaging results versus MR imaging not performed (odds ratio, 1.86; 95% confidence interval: 0.57, 6.06) were significantly predictive of treatment need. In multivariable analysis, radiographic results (odds ratio, 24.7; 95% confidence interval: 6.59, 93.1) and positive MR imaging results (odds ratio, 6.28; 95% confidence interval: 1.27, 31.0) were significantly predictive of treatment need. Negative MR imaging results were not significantly predictive (odds ratio, 0.87; 95% confidence interval: 0.20, 3.82).

CONCLUSION: A short MR imaging examination with a low-field-strength MR imaging system following radiography in initial evaluation of patients with acute wrist trauma has additional value in prediction of treatment need; it does not have value in identification of patients who can be discharged without further follow-up.

© RSNA, 2005

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