For example, Haubro et al [26] found a sensitivity for CT of 87% compared with 100% for MRI, with CT missing 6 of 15 fractures. Another larger study of 129 cases compared MRI and CT for the diagnosis of both proximal femoral and pelvic fractures and found a sensitivity of 99% for MRI and 69% for CT using clinical outcomes and follow-up imaging as the gold standard [39]. This same study by Cabarrus et al [39] also found MRI to be substantially better at detecting soft-tissue abnormalities with 99% sensitivity for MRI and 13% sensitivity edema, and the differences in sensitivity for more significant injuries, such as hematoma or tendon avulsion, may be somewhat less. Several other similar studies comparing CT and MRI have also shown decreased sensitivity of CT with potential for missed fractures as well as changes in diagnosis and management when MRI is obtained after CT [24,47,48]. There is no relevant data to support the use of contrast-enhanced CT solely for the purpose of fracture detection following negative radiographs. However, if contrast-enhanced CT examination of the abdomen and pelvis is performed because of suspicion of concurrent intra-abdominal trauma, bone algorithm reconstruction of the pelvis and hips may be performed rather than performing a separate examination. There is no relevant data to support the use of multiphase CT for the detection of fractures of the pelvis and proximal femur. Dual-energy CT is a more recent technology that has the ability to produce virtual noncalcium images for the detection of bone marrow edema. Although the technology holds promise, diagnostic accuracy does not yet approach that of MRI, with an initial study by Reddy et al [49] demonstrating a sensitivity of 90% and specificity of 40% for nondisplaced femoral neck fractures. However, this may be a modality of emerging importance as technology improves.
Acute Hip Pain Suspected Fracture PCAs. For example, Haubro et al [26] found a sensitivity for CT of 87% compared with 100% for MRI, with CT missing 6 of 15 fractures. Another larger study of 129 cases compared MRI and CT for the diagnosis of both proximal femoral and pelvic fractures and found a sensitivity of 99% for MRI and 69% for CT using clinical outcomes and follow-up imaging as the gold standard [39]. This same study by Cabarrus et al [39] also found MRI to be substantially better at detecting soft-tissue abnormalities with 99% sensitivity for MRI and 13% sensitivity edema, and the differences in sensitivity for more significant injuries, such as hematoma or tendon avulsion, may be somewhat less. Several other similar studies comparing CT and MRI have also shown decreased sensitivity of CT with potential for missed fractures as well as changes in diagnosis and management when MRI is obtained after CT [24,47,48]. There is no relevant data to support the use of contrast-enhanced CT solely for the purpose of fracture detection following negative radiographs. However, if contrast-enhanced CT examination of the abdomen and pelvis is performed because of suspicion of concurrent intra-abdominal trauma, bone algorithm reconstruction of the pelvis and hips may be performed rather than performing a separate examination. There is no relevant data to support the use of multiphase CT for the detection of fractures of the pelvis and proximal femur. Dual-energy CT is a more recent technology that has the ability to produce virtual noncalcium images for the detection of bone marrow edema. Although the technology holds promise, diagnostic accuracy does not yet approach that of MRI, with an initial study by Reddy et al [49] demonstrating a sensitivity of 90% and specificity of 40% for nondisplaced femoral neck fractures. However, this may be a modality of emerging importance as technology improves.