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Jorisal P, Sulay CBH, Octavius GS. An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures. J Clin Med 2024; 13:3769. [PMID: 38999335 PMCID: PMC11242027 DOI: 10.3390/jcm13133769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024525388). The literature search started and ended on 17 March 2024. We searched seven academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, Google Scholar, WHO International Clinical Trials Registry Platform, and The Joanna Briggs Institute (JBI) database. The meta-analysis was conducted with the STATA program using the "midas" command. Results: There are four systematic reviews evaluating occult hip and femoral fractures with 6174 patients and two reviews evaluating occult scaphoid fractures with 1355 patients. The prevalence of occult scaphoid fracture and occult hip and femoral fractures is 23.87% (95% CI 18.25-29.49) and 44.8% (95% CI 39.38-51.4), respectively. Magnetic resonance imaging (MRI) had the best posterior probability of positive likelihood ratio (LR+) with 95% and 96% and negative likelihood ratio (LR-) with 0.15% and 1% for both occult scaphoid and hip fractures, respectively, assuming a 25% baseline. MRI could both confirm and exclude occult hip fractures while it can only confirm occult scaphoid fractures. Bone scans are inappropriate for either type of occult fractures The level of evidence for occult scaphoid fracture is weak while it is suggestive for occult hip fractures. Conclusion: The findings strengthen the use of MRI after an initially negative radiograph fracture for occult hip and femoral fractures, with a CT scan as a viable second option.
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Affiliation(s)
- Patricia Jorisal
- Abdominal Radiology, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 12930, Indonesia
- Department of Radiology, Siloam Hospital Kebon Jeruk, Jakarta 11530, Indonesia
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2
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Chaban YV, Vosshenrich J, McKee H, Gunasekaran S, Brown MJ, Atalay MK, Heye T, Markl M, Woolen SA, Simonetti OP, Hanneman K. Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action. J Magn Reson Imaging 2024; 59:1149-1167. [PMID: 37694980 DOI: 10.1002/jmri.28994] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Yuri V Chaban
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suvai Gunasekaran
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maura J Brown
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Atalay
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tobias Heye
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Sean A Woolen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | | | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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3
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Ibrahim F, Cadour F, Campbell-Washburn AE, Allen BD, Vosshenrich J, Brown MJ, Thavendiranathan P, Hanneman K, Moy L. Energy and Greenhouse Gas Emission Savings Associated with Implementation of an Abbreviated Cardiac MRI Protocol. Radiology 2024; 311:e240588. [PMID: 38652029 PMCID: PMC11070609 DOI: 10.1148/radiol.240588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
Supplemental material is available for this article. See also the article by Lenkinski and Rofsky in this issue. See also the article by McKee et al in this issue.
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Affiliation(s)
- Fadi Ibrahim
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Farah Cadour
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Adrienne E. Campbell-Washburn
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Bradley D. Allen
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Jan Vosshenrich
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Maura J. Brown
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Kate Hanneman
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Linda Moy
- From the Department of Medical Imaging, University Medical Imaging
Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T.,
K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
(A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of
Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital
Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine,
University of British Columbia, Vancouver, Canada (M.J.B.); Division of
Cardiology, Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, 585 University Ave,
1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
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4
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Kuhl CK. Abbreviated Breast MRI: State of the Art. Radiology 2024; 310:e221822. [PMID: 38530181 DOI: 10.1148/radiol.221822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Abbreviated MRI is an umbrella term, defined as a focused MRI examination tailored to answer a single specific clinical question. For abbreviated breast MRI, this question is: "Is there evidence of breast cancer?" Abbreviated MRI of the breast makes maximum use of the fact that the kinetics of breast cancers and of benign tissue differ most in the very early postcontrast phase; therefore, abbreviated breast MRI focuses on this period. The different published approaches to abbreviated MRI include the following three subtypes: (a) short protocols, consisting of a precontrast and either a single postcontrast acquisition (first postcontrast subtracted [FAST]) or a time-resolved series of postcontrast acquisitions with lower spatial resolution (ultrafast [UF]), obtained during the early postcontrast phase immediately after contrast agent injection; (b) abridged protocols, consisting of FAST or UF acquisitions plus selected additional pulse sequences; and (c) noncontrast protocols, where diffusion-weighted imaging replaces the contrast information. Abbreviated MRI was proposed to increase tolerability of and access to breast MRI as a screening tool. But its widening application now includes follow-up after breast cancer and even diagnostic assessment. This review defines the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility.
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Affiliation(s)
- Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH Pauwelsstr 30, 52074 Aachen, Germany
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5
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Mennen AHM, Blokland AS, Maas M, van Embden D. Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review. Osteoporos Int 2023; 34:1549-1559. [PMID: 37286662 PMCID: PMC10427539 DOI: 10.1007/s00198-023-06812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard; however, MRI has even greater diagnostic accuracy. Dual energy computed tomography (DECT) is a new and promising imaging technique, but the diagnostic accuracy in the context of pelvic fragility fractures (FFPs) has not been widely established. The aim was to provide insight into the diagnostic accuracy of different imaging techniques and the relevance for clinical practice. A systematic search was performed in the PubMed database. All studies that reported on CT, MRI or DECT imaging techniques in older adults who suffered a pelvic fracture were reviewed and, if relevant, included. Eight articles were included. In up to 54% of the patients, additional fractures were found on MRI compared to CT, and in up to 57% of the patients on DECT. The sensitivity of DECT for posterior pelvic fracture detection was similar to MRI. All patients without fractures on CT appeared to have posterior fractures on MRI. After additional MRI, 40% of the patients had a change of classification. DECT and MRI showed very similar results in terms of diagnostic accuracy. Over a third of all patients appear to have a more severe fracture classification after MRI, the majority changing to Rommens type 4. However, in only a few patients who changed of fracture classification, a change of therapy was advised. This review suggests that MRI and DECT scans are superior in diagnosing FFPs.
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Affiliation(s)
- Anna H M Mennen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Alida S Blokland
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mario Maas
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Daphne van Embden
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
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6
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Cahill DG, Yam MKH, Griffith JF. Imaging of the Acutely Injured Hip. Radiol Clin North Am 2023; 61:203-217. [PMID: 36739142 DOI: 10.1016/j.rcl.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute hip pain following injury more commonly originates locally in and around the hip joint rather than being referred from the lumbar spine, sacroiliac joints, groin, or pelvis. Clinical assessment can usually localize the pain source to the hip region. Thereafter, imaging helps define the precise cause of acute hip pain. This review discusses the imaging of common causes of acute hip pain following injury in adults, addressing injuries in and around the hip joint. Pediatric and postsurgical causes of hip pain following injury are not discussed.
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Affiliation(s)
- Donal G Cahill
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, The Prince of Wales Hospital, Ngai Shing Street, Shatin, Hong Kong
| | - Max K H Yam
- Department of Radiology, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, The Prince of Wales Hospital, Ngai Shing Street, Shatin, Hong Kong.
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7
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Artificial Intelligence (AI) for Fracture Diagnosis: An Overview of Current Products and Considerations for Clinical Adoption, From the AJR Special Series on AI Applications. AJR Am J Roentgenol 2022; 219:869-878. [PMID: 35731103 DOI: 10.2214/ajr.22.27873] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fractures are common injuries that can be difficult to diagnose, with missed fractures accounting for most misdiagnoses in the emergency department. Artificial intelligence (AI) and, specifically, deep learning have shown a strong ability to accurately detect fractures and augment the performance of radiologists in proof-of-concept research settings. Although the number of real-world AI products available for clinical use continues to increase, guidance for practicing radiologists in the adoption of this new technology is limited. This review describes how AI and deep learning algorithms can help radiologists to better diagnose fractures. The article also provides an overview of commercially available U.S. FDA-cleared AI tools for fracture detection as well as considerations for the clinical adoption of these tools by radiology practices.
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8
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Mandell JC, Khurana B. Musculoskeletal Trauma and Infection. Magn Reson Imaging Clin N Am 2022; 30:441-454. [PMID: 35995472 DOI: 10.1016/j.mric.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Musculoskeletal Imaging and Intervention, Division of Musculoskeletal Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Brigham and Women's Hospital, Trauma Imaging Research and Innovation Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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9
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Shafiei M, Chalian M, Luna R, Ahlawat S, Fayad LM. Imaging in Musculoskeletal Oncology. Radiol Clin North Am 2022; 60:657-668. [DOI: 10.1016/j.rcl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Low YL, Finkelstein E. Cost-Effective Analysis of Dual-Energy Computed Tomography for the Diagnosis of Occult Hip Fractures Among Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1754-1762. [PMID: 34838273 DOI: 10.1016/j.jval.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Early and accurate diagnosis of hip fractures minimizes morbidity and mortality. Although current guidelines favor magnetic resonance imaging (MRI) for the diagnosis of occult hip fractures, a new technology called dual-energy computed tomography (DECT) seems an effective alternative. This article investigates a potentially cost-effective strategy for the diagnosis of occult hip fractures in older adults in Singapore. METHODS A decision tree model was developed to compare costs from a payer's perspective and outcomes in terms of quality-adjusted life-years (QALYs) of different imaging strategies for diagnosing occult hip fracture, comparing MRI with DECT supplementing single-energy computed tomography (SECT) and SECT alone. Model inputs were obtained from local sources where available. Sensitivity analyses are performed to test the robustness of the results. RESULTS The MRI strategy was dominated by the DECT strategy, whereas DECT supplementing SECT provided 0.30 more QALYs at an incremental cost of SGD106.41 with an incremental cost-effectiveness ratio of SGD352.52 per QALY relative to SECT alone. DECT seemed a cost-effective strategy at a willingness-to-pay threshold of SGD50 000 per QALY. CONCLUSION DECT supplementing SECT is a cost-effective imaging strategy to diagnose occult hip fractures among older adults in Singapore and should be included in clinical pathways to expedite timely treatment and considered for reimbursement schemes.
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Affiliation(s)
- Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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11
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Nishi M, Yoshikawa Y, Kaji Y, Okano I, Inagaki K. Multi-Site Insufficiency Pelvic Fracture Following Total Hip Arthroplasty. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927776. [PMID: 33372173 PMCID: PMC7780195 DOI: 10.12659/ajcr.927776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 47-year-old Final Diagnosis: Pelvic fracture Symptoms: Hip pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yasushi Yoshikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yasutaka Kaji
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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12
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Sun EX, Mandell JC, Weaver MJ, Kimbrell V, Harris MB, Khurana B. Clinical utility of a focused hip MRI for assessing suspected hip fracture in the emergency department. Emerg Radiol 2020; 28:317-325. [PMID: 33175269 DOI: 10.1007/s10140-020-01870-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE A focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED) in 2013. The goal of this study was to assess the clinical utility of this protocol. METHODS We retrospectively reviewed radiology reports of 262 unique patients who underwent 263 FHMR (coronal T1, coronal STIR, axial T2 fat saturated) for suspected hip fracture in the ED from October 2013 to March 2020. Electronic medical records were reviewed for the ED course, follow-up imaging, and clinical management within 90 days. RESULTS Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR. CONCLUSIONS FHMR offers reliable identification of radiographically occult hip fractures and muscle/tendon injuries. The protocol is well trusted in guiding patient management in our ED.
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Affiliation(s)
- Ellen X Sun
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA.
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Michael J Weaver
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Vera Kimbrell
- Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC, 27710, USA.,Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
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13
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Wilson MP, Nobbee D, Murad MH, Dhillon S, McInnes MDF, Katlariwala P, Low G. Diagnostic Accuracy of Limited MRI Protocols for Detecting Radiographically Occult Hip Fractures: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 215:559-567. [PMID: 32755182 DOI: 10.2214/ajr.19.22676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of limited MRI protocols for detecting radiographically occult proximal femoral fractures. MATERIALS AND METHODS. A systematic review of MEDLINE, Embase, Scopus, the Cochrane Library, and the gray literature through November 15, 2019, was performed. Original articles with 10 or more patients evaluating limited MRI protocols for the diagnosis of radiographically occult proximal femoral fractures compared with multiparametric MRI with or without clinical outcome as the reference standard were included in the analysis. Patient, clinical, MRI, and performance parameters were independently acquired by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model. RESULTS. Eleven studies with 938 patients and 247 proximal femoral fractures met inclusion criteria, and five of these studies were included in the meta-analysis. The pooled and weighted summary sensitivity and specificity and the area under the summary ROC curve for limited MRI protocols in detecting radiographically occult hip fractures were 99% (95% CI, 91-100%), 99% (95% CI, 97-100%), and 1 (95% CI, 0.99-1), respectively. The aggregate sensitivity and specificity values for a single-plane T1-weighted sequence only, STIR sequence only, T1-weighted and STIR sequences, and T2-weighted sequence only were as follows: 97% (89/92) and 100% (76/76), 99% (126/127) and 99% (865/873), 100% (118/118) and 99% (867/874), and 86% (51/59) and 97% (137/141), respectively. Sensitivity was 100% (58/58) when images were acquired on 3-T scanners only and 99% (284/288) when interpreted only by certified radiologists. The mean scanning time for the limited MRI protocols was less than 5 minutes. CONCLUSION. Limited MRI protocols can be used as the standard of care in patients with a suspected but radiographically occult hip fracture. A protocol composed of coronal T1-weighted and STIR sequences is 100% sensitive.
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Affiliation(s)
- Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St NW, 2B2.41 WMC, Edmonton, AB T6G 2B7, Canada
| | - Dorian Nobbee
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St NW, 2B2.41 WMC, Edmonton, AB T6G 2B7, Canada
| | | | - Suki Dhillon
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St NW, 2B2.41 WMC, Edmonton, AB T6G 2B7, Canada
| | - Matthew D F McInnes
- Department of Radiology, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St NW, 2B2.41 WMC, Edmonton, AB T6G 2B7, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St NW, 2B2.41 WMC, Edmonton, AB T6G 2B7, Canada
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14
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Abbreviated Musculoskeletal MRI Protocols: Point-Improved Patient Access and Reduced Health Care Costs. AJR Am J Roentgenol 2020; 216:33-34. [PMID: 32603225 DOI: 10.2214/ajr.20.24004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Oetelaar G, Heng HG, Lim CK, Cox A, Weng HY. Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues. J Forensic Sci 2020; 65:1524-1529. [PMID: 32525570 DOI: 10.1111/1556-4029.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes-so-called bone marrow edema-may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI-particularly the T1W sequence-can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.
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Affiliation(s)
- Garrett Oetelaar
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
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16
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Singer AD, Umpierrez M, Kakarala A, Schechter MC, Maceroli M, Sharma GB, Rajani RR. Performance of a rapid two-sequence screening protocol for osteomyelitis of the foot. Skeletal Radiol 2020; 49:977-984. [PMID: 31938864 DOI: 10.1007/s00256-019-03367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Compare a two sequence protocol to a standard protocol in the detection of pedal osteomyelitis (OM) and abscesses and to identify patients that benefit from a full protocol. MATERIALS AND METHODS One hundred thirty-two foot MRIs ordered to assess for OM were enrolled, and the following items were extracted from the clinical reports: use of IV contrast, the presence of OM, reactive osteitis, and a soft tissue abscess. Using only one T1 nonfat-suppressed and one fluid sensitive fat-suppressed sequences, two experienced musculoskeletal radiologists reviewed each case for the presence of OM, reactive osteitis, or an abscess. A Kappa test was calculated to assess for interobserver agreement, and diagnostic performance was determined. The McNemar test was used to assess for the effect of contrast. RESULTS Agreement between both observers and the clinical report on the presence of osteomyelitis was substantial ( k = 0.63 and 0.72, p < 0.001), while the agreement for abscess was fair (k = 0.29 and 0.38, p < 0.001). For osteomyelitis, both observers showed good accuracy (0.85 and 0.86). When screening bone for a normal versus abnormal case, this method was highly sensitive (0.97-0.98), but was less sensitive for abscess (0.63-0.75). Fifty-one percent of exams used contrast, and it did impact the diagnosis of abscess for one observer. CONCLUSION This rapid protocol is accurate in making the diagnosis of OM, and its high sensitivity makes it useful to screen for patients that would benefit from a full protocol.
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Affiliation(s)
- Adam D Singer
- Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Aparna Kakarala
- Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Marcos C Schechter
- Department of Medicine, Division of Infectious Disease, Emory University Hospital, Atlanta, GA, USA
| | - Michael Maceroli
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | | | - Ravi R Rajani
- Department of Surgery, Division of Vascular Surgery, Emory University Hospital, Atlanta, GA, USA
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17
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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18
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Robinson JD, Gross JA, Cohen WA, Linnau KF. Operational Considerations in Emergency Radiology. Semin Roentgenol 2020; 55:83-94. [PMID: 32438983 PMCID: PMC7255322 DOI: 10.1053/j.ro.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Joel A Gross
- Department of Radiology, University of Washington, Seattle, WA
| | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
| | - Ken F Linnau
- Department of Radiology, University of Washington, Seattle, WA
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19
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Yoshida N, Tsuchida Y, Murakami H, Shirakawa T, Futamura K, Kohzuki M. Time-Dependent Magnetic Resonance Imaging Changes in Occult Femoral Neck Fracture During Conservative Treatment: A Case Report. JBJS Case Connect 2020; 10:e0570. [PMID: 32224676 DOI: 10.2106/jbjs.cc.19.00570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 53-year-old woman presented to the emergency department with persistent left hip pain after a fall while riding a bicycle. Although x-ray imaging revealed no evidence of fracture, an abnormal intensity vertical line along the left femoral neck was observed in the magnetic resonance imaging (MRI). Furthermore, 2 weeks after injury, MRI revealed a newly developed abnormal intensity oblique band at the femoral neck. After discussing several treatment options with the patients, she chose the conservative treatment. CONCLUSION Careful follow-ups and MRI were undertaken 6 times within 32 weeks. Bone union was observed 32 weeks after the injury, and no bone displacement was observed.
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Affiliation(s)
- Naoki Yoshida
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroko Murakami
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tetsuya Shirakawa
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kentaro Futamura
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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20
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Kuhl CK. Abbreviated Magnetic Resonance Imaging (MRI) for Breast Cancer Screening: Rationale, Concept, and Transfer to Clinical Practice. Annu Rev Med 2019; 70:501-519. [PMID: 30691370 DOI: 10.1146/annurev-med-121417-100403] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Given the increasing understanding of cancer as a heterogeneous group of diseases, detection methods should offer a sensitivity profile that ensures perfect sensitivity for biologically important cancers while screening out self-limiting pseudocancers. However, mammographic screening is biased toward detection of ductal carcinoma in situ and slowly growing cancers-and thus frequently fails to detect biologically aggressive cancers. This explains the persistently high rates of interval cancers and high rates of breast cancer mortality observed in spite of decades of mammographic screening. Magnetic resonance imaging (MRI), in contrast, has a sensitivity profile that matches clinical needs. Conventional MRI is not suitable for population-wide screening due to high cost, limited tolerability, and lack of availability. We introduced abbreviated MRI in 2014. Abbreviated MRI will change the way MRI is used in clinical medicine. This article describes the rationale to use MRI in general, and abbreviated MRI in particular, for breast cancer screening.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, 52074 Aachen, Germany;
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21
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Hackenbroch C, Merz C, Palm HG, Friemert B, Stuby F, Lang P. Magnetic Resonance Imaging in Pelvic Fractures – Part 2: Gaining Information and Clinical Therapeutic Relevance. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:360-368. [DOI: 10.1055/a-0965-7686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy.
Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting.
Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisherʼs Exact Test found that the parameters “adequacy of trauma” and “fracture type change” by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have
changed pro forma.
Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.
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Affiliation(s)
| | - Charlotte Merz
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
| | - Hans-Georg Palm
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
| | - Benedikt Friemert
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
| | - Fabian Stuby
- Casualty Hospital, Occupational Accident Casualty Hospital, Murnau
| | - Patricia Lang
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
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22
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Multi-detector CT for suspected hip fragility fractures: A diagnostic test accuracy systematic review and meta-analysis. Emerg Radiol 2019; 26:549-556. [PMID: 31209592 DOI: 10.1007/s10140-019-01696-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
To perform a systematic review (SR) and meta-analysis to determine the diagnostic test accuracy (DTA) of Multi-Detector Computed Tomography (MDCT) for detecting proximal femoral (hip) fragility fractures in patients with a negative initial radiograph. MEDLINE and EMBASE were searched to identify relevant studies published between January 2000 and May 2018. Articles underwent title and abstract screening followed by full-text screening. Study inclusion criteria are patients with suspected hip fracture, negative initial radiograph, MDCT as the index test, magnetic resonance imaging (MRI) or clinical follow-up as the reference standard, and DTA measure as the outcome. Demographic, methodologic, and study outcome data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. DTA metrics were pooled using bivariate random-effects meta-analysis. From an initial 1385 studies, four studies reporting on 418 patients (174 with hip fractures) were included. Pooled summary statistics included the following: sensitivity (87%; 95% confidence interval [CI] 79-93), specificity (98%; 95% CI 95-99), and the area under the summary receiver operating characteristic (ROC) curve (0.972). MDCT has a high specificity for detecting hip fragility fractures, comparable to MRI, but a lower sensitivity. Local institutional factors may play a role in whether a patient receives MDCT or MRI, as imaging should not be delayed. If there is ongoing concern for fracture in a patient with a negative MDCT, MRI should be performed. Cautious interpretation of the results is warranted given the risk of bias and small sample size.
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