This specialist, very fast limited scan can be used as 2nd or 3rd line imaging for suspected scaphoid fracture. It is a single plane, low detail scan which aims to detect bone marrow oedema and show a fracture line.
It needs to be carefully used, with education of referrers to understand that they are not getting an in depth scan of the wrist but a study to discover or discount the diagnosis of scaphoid fracure. In our practice, this is used as 2nd line imaging after 2 normal x-rays and review in the fracture clinic. It is typically carried out 10-14 days post-injury at the review appointment.
Scan
- Superman position with hand in magnetic isocentre or hand by flank if not tolerated
- High resolution hand / wrist coil if available
- 10-minute turnaround
| Sequence |
|---|
| T2 STIR Coronal |
| T1 Coronal |
What if I see some other pathology?
For this study it is not recommended that you carry out additional adhoc sequences because:
- This is deliberately a short ‘fit in’ scan
- It is intended as a problem solving focussed scan
Notes for reporters
Quite often this study will be reported in a very simplistic manner as it is a focussed, question answering scan:
No bone marrow oedema in the scaphoid. No scaphoid fracture detected.
However, it is not at all infrequent to detect other fractures and it is important to describe the location of the other fracture but to appreciate that detail cannot be provided.
Bone marrow oedema is present in the triquetral suspect of fracture. No scaphoid bone marrow oedema.
It is always worth mentioning the gross alignment of the carpal rows, as occasionally interval widening can be detected in relation to a ligament injury.
The proximal and distal carpal rows remain normally aligned.