Acute Hand and Wrist Trauma Like CT, MRI shows intra-articular extension of distal radius fractures more frequently than radiography. Unlike CT, MRI shows concomitant ligament injuries, including tears of the scapholunate ligament, which may affect surgical treatment [26,27]. Despite these advantages, MRI performed immediately at the time of injury has little added value for determining which patients go on to surgery [23]. MRI is especially useful in evaluating hand soft-tissues injuries, including the collateral ligaments, volar plates, tendons, and pulleys. For metacarpal and digital fractures, MRI is usually not indicated during acute injury [22]. There is no evidence to support the use of MRI with IV contrast in the setting of acute hand and wrist trauma. US Area of Interest US may have a limited utility for evaluating bone injuries. Christiansen et al [28] reported 47% sensitivity and 61% specificity of US for the detection of scaphoid fractures. They concluded that US is not suitable for the early diagnosis of scaphoid fracture. In contrast, Hauger et al [29] reported that using cortical disruption as a diagnostic criterion on US is an accurate sign for detecting occult fractures of the scaphoid waist. Further study of US for the diagnosis of occult fractures is needed. Bone Scan Area of Interest Bone scan is not indicated in this clinical setting. CT Arthrography Wrist When conventional radiographs do not show carpal malalignment, CT arthrography may be used to diagnose ligamentous tears, causing dynamic instability [32,33]. There is a growing body of literature comparing the diagnostic accuracy of MRI (at 1.5T or 3T), MR arthrography (indirect or direct at 1.5T or 3T), and CT arthrography. Overall, CT arthrography is reported to have the highest sensitivity, specificity, and accuracy. For the detection of scapholunate ligament tear, CT arthrography has sensitivity, specificity, and accuracy of nearly 100%.
Acute Hand and Wrist Trauma. Acute Hand and Wrist Trauma Like CT, MRI shows intra-articular extension of distal radius fractures more frequently than radiography. Unlike CT, MRI shows concomitant ligament injuries, including tears of the scapholunate ligament, which may affect surgical treatment [26,27]. Despite these advantages, MRI performed immediately at the time of injury has little added value for determining which patients go on to surgery [23]. MRI is especially useful in evaluating hand soft-tissues injuries, including the collateral ligaments, volar plates, tendons, and pulleys. For metacarpal and digital fractures, MRI is usually not indicated during acute injury [22]. There is no evidence to support the use of MRI with IV contrast in the setting of acute hand and wrist trauma. US Area of Interest US may have a limited utility for evaluating bone injuries. Christiansen et al [28] reported 47% sensitivity and 61% specificity of US for the detection of scaphoid fractures. They concluded that US is not suitable for the early diagnosis of scaphoid fracture. In contrast, Hauger et al [29] reported that using cortical disruption as a diagnostic criterion on US is an accurate sign for detecting occult fractures of the scaphoid waist. Further study of US for the diagnosis of occult fractures is needed. Bone Scan Area of Interest Bone scan is not indicated in this clinical setting. CT Arthrography Wrist When conventional radiographs do not show carpal malalignment, CT arthrography may be used to diagnose ligamentous tears, causing dynamic instability [32,33]. There is a growing body of literature comparing the diagnostic accuracy of MRI (at 1.5T or 3T), MR arthrography (indirect or direct at 1.5T or 3T), and CT arthrography. Overall, CT arthrography is reported to have the highest sensitivity, specificity, and accuracy. For the detection of scapholunate ligament tear, CT arthrography has sensitivity, specificity, and accuracy of nearly 100%.