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Occult Scaphoid Fractures: Comparison of Multidetector CT and MR Imaging—Initial Experience¹

¹ From the Departments of Radiology (M.M., M.J.B., C.S., M.W., M.P.) and Traumatology (S.A., C.G.), Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Received March 11, 2005; revision requested May 4; revision received May 31; accepted June 21; final version accepted August 25. Address correspondence to M.M. (e-mail: mazda.memarsadeghi{at}meduniwien.ac.at).

View larger version (149K): [in a new window]   Figure 1a: Trabecular scaphoid fracture in a 23-year-old man. (a) Coronal T1-weighted (500/20) MR image obtained 2 days after trauma shows hypointense network of lines (circle) in the middle third of scaphoid bone. Coronal (b) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) and (c) STIR (1200/13/130) MR images show highly increased signal intensity in the bone marrow (arrow). (d) Multidetector CT scan shows no sign of fracture.

View larger version (132K): [in a new window]   Figure 1b: Trabecular scaphoid fracture in a 23-year-old man. (a) Coronal T1-weighted (500/20) MR image obtained 2 days after trauma shows hypointense network of lines (circle) in the middle third of scaphoid bone. Coronal (b) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) and (c) STIR (1200/13/130) MR images show highly increased signal intensity in the bone marrow (arrow). (d) Multidetector CT scan shows no sign of fracture.

View larger version (110K): [in a new window]   Figure 1c: Trabecular scaphoid fracture in a 23-year-old man. (a) Coronal T1-weighted (500/20) MR image obtained 2 days after trauma shows hypointense network of lines (circle) in the middle third of scaphoid bone. Coronal (b) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) and (c) STIR (1200/13/130) MR images show highly increased signal intensity in the bone marrow (arrow). (d) Multidetector CT scan shows no sign of fracture.

View larger version (144K): [in a new window]   Figure 1d: Trabecular scaphoid fracture in a 23-year-old man. (a) Coronal T1-weighted (500/20) MR image obtained 2 days after trauma shows hypointense network of lines (circle) in the middle third of scaphoid bone. Coronal (b) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) and (c) STIR (1200/13/130) MR images show highly increased signal intensity in the bone marrow (arrow). (d) Multidetector CT scan shows no sign of fracture.

View larger version (146K): [in a new window]   Figure 2a: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (138K): [in a new window]   Figure 2b: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (147K): [in a new window]   Figure 2c: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (155K): [in a new window]   Figure 2d: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (111K): [in a new window]   Figure 2e: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (134K): [in a new window]   Figure 2f: Complete scaphoid fracture in a 25-year-old man. (a) Initial conventional radiograph is negative; (b) after 6 weeks, a clear fracture line could be seen. Coronal (c) T1-weighted (500/20), (d) T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle), and (e) STIR (1200/13/130) MR images obtained 4 days after trauma demonstrate complete cortical and trabecular fracture line in the scaphoid bone that is hypointense on c (arrow) and hyperintense on d and e. (f) Coronal multiplanar reformation from multidetector CT performed on the same day shows nondisplaced fracture of the scaphoid.

View larger version (133K): [in a new window]   Figure 3a: Cortical scaphoid fracture in a 36-year-old woman. (a) Coronal T1-weighted (500/20) MR image obtained 6 days after trauma shows hypointense fracture line (arrow) in the scaphoid bone. (b) Coronal T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) MR image demonstrates hyperintense fracture line (arrow). Although medial extension of the fracture line could be postulated retrospectively, cortical disruption was not diagnosed prospectively. (c) Transverse multiplanar reformation from multidetector CT shows fracture (arrow) involving dorsal cortex of the scaphoid, which is also seen on (d) CT coronal multiplanar reformation.

View larger version (137K): [in a new window]   Figure 3b: Cortical scaphoid fracture in a 36-year-old woman. (a) Coronal T1-weighted (500/20) MR image obtained 6 days after trauma shows hypointense fracture line (arrow) in the scaphoid bone. (b) Coronal T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) MR image demonstrates hyperintense fracture line (arrow). Although medial extension of the fracture line could be postulated retrospectively, cortical disruption was not diagnosed prospectively. (c) Transverse multiplanar reformation from multidetector CT shows fracture (arrow) involving dorsal cortex of the scaphoid, which is also seen on (d) CT coronal multiplanar reformation.

View larger version (124K): [in a new window]   Figure 3c: Cortical scaphoid fracture in a 36-year-old woman. (a) Coronal T1-weighted (500/20) MR image obtained 6 days after trauma shows hypointense fracture line (arrow) in the scaphoid bone. (b) Coronal T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) MR image demonstrates hyperintense fracture line (arrow). Although medial extension of the fracture line could be postulated retrospectively, cortical disruption was not diagnosed prospectively. (c) Transverse multiplanar reformation from multidetector CT shows fracture (arrow) involving dorsal cortex of the scaphoid, which is also seen on (d) CT coronal multiplanar reformation.

View larger version (132K): [in a new window]   Figure 3d: Cortical scaphoid fracture in a 36-year-old woman. (a) Coronal T1-weighted (500/20) MR image obtained 6 days after trauma shows hypointense fracture line (arrow) in the scaphoid bone. (b) Coronal T2-weighted three-dimensional gradient-echo (60/17, 20° flip angle) MR image demonstrates hyperintense fracture line (arrow). Although medial extension of the fracture line could be postulated retrospectively, cortical disruption was not diagnosed prospectively. (c) Transverse multiplanar reformation from multidetector CT shows fracture (arrow) involving dorsal cortex of the scaphoid, which is also seen on (d) CT coronal multiplanar reformation.