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de Zwart AD, Beeres FJ, Rietbergen DD, et al. Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture. Acta Radiol Open. 2015;4(10):2058460115602729doi: 10.1177/2058460115602729.
de Zwart, A. D., Beeres, F. J., Rietbergen, D. D., Krijnen, P., & Schipper, I. B. (2015). Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture. Acta radiologica open, 4(10), 2058460115602729. https://doi.org/10.1177/2058460115602729
de Zwart, Andele D, et al. "Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture." Acta radiologica open vol. 4,10 (2015): 2058460115602729. doi: https://doi.org/10.1177/2058460115602729
de Zwart AD, Beeres FJ, Rietbergen DD, Krijnen P, Schipper IB. Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture. Acta Radiol Open. 2015 Oct 08;4(10):2058460115602729. doi: 10.1177/2058460115602729. eCollection 2015 Oct. PMID: 26500783; PMCID: PMC4601125.
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Acta Radiol Open. 2015 Oct 08;4(10):2058460115602729. doi: 10.1177/2058460115602729. eCollection 2015 Oct.

Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture.

Acta radiologica open

Andele D de Zwart, Frank Jp Beeres, Daphne Dd Rietbergen, Pieta Krijnen, Inger B Schipper

Affiliations

  1. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
  2. Department of Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
  3. Department of Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands.

PMID: 26500783 PMCID: PMC4601125 DOI: 10.1177/2058460115602729

Abstract

BACKGROUND: *Equal contributors.Planar bone scintigraphy (PBS) is often advocated for diagnosing occult scaphoid fractures. PBS is a sensitive diagnostic modality, but lacks specificity, which may result in over-diagnosis.

PURPOSE: To examine, in a pilot study, the potential additional value of single photon emission computed tomography (SPECT) combined with low dose computed tomography (CT) for the diagnosis of an occult scaphoid fracture.

MATERIAL AND METHODS: Ten patients that underwent combined PBS and SPECT/CT for a clinically suspected scaphoid fracture, where radiographs could not detect a fracture, were included in this pilot study. The PBS and SPECT/CT results were independently and separately evaluated by a nuclear physician for scaphoid fractures and other injuries.

RESULTS: PBS was positive for a scaphoid fracture in four patients and diagnosed three other fractures. SPECT/CT showed five scaphoid fractures and one other fracture. SPECT/CT - PBS had discrepant results in three patients. In two patients PBS diagnosed a trapezoid fracture where SPECT/CT showed a scaphoid fracture. The other patient was diagnosed with a scaphoid fracture on PBS, whereas SPECT/CT showed bone bruise of other carpal bones.

CONCLUSION: SPECT/CT has the potential to be more accurate than PBS as it uses anatomical information of the CT to discriminate between the scaphoid, other carpal bones, and bone bruises. Larger studies with an independent reference standard are needed for confirmation of these preliminary data.

Keywords: Scaphoid bone; computed tomography (CT); fracture; single photon emission computed tomography (SPECT)

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