Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures.

Background: The diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of nonunion risk. Currently, new hybrid technologies are emerging such as SPECT/CT systems, which combine functional and anatomical data sets. So, we wanted to evaluate the utility of SPECT/CT in the management of occult carpal fractures.

Methods: In this study, all patients addressed at the orthopedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs were prospectively included. Patients with normal radiographs but with signs strongly suggestive of clinical fracture underwent a bone SPECT/CT and an MRI of the wrist. Therapeutic management took into account the results of all modalities, and all patients were followed up for at least 6 months and reviewed by the same surgeon. SPECT/CT findings were compared with those of the other modalities and follow-up.

Results: From December 2009 to May 2011, 57 patients were enrolled. Fifty-seven SPECT/CT and 52 MRI scans were obtained. Twenty-eight patients had normal imaging results, whereas 29 patients presented bone bruise and/or fractures. Ten patients were concordant according to SPECT/CT and MRI; 2 patients presented fractures on SPECT/CT without MRI performed; 17 patients had partially discordant results. Only 1 patient presented a nonunion at the follow-up, whereas both investigations were positive.

Conclusions: This study highlights the good performances of SPECT/CT, which allows the detection of most occult carpal fractures. When a carpal occult fracture is strongly suspected clinically, SPECT/CT might be proposed at first intention after normal radiographs.