Brathaban Rajayogeswaran MBBCh, Presenter: Nothing to Disclose

Neal C. Chhaya MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

Patrick McLaughlin FFR(RCSI), Abstract Co-Author: Nothing to Disclose

Savvas Nicolaou MD, Abstract Co-Author: Nothing to Disclose

Hugue A. Ouellette MD, Abstract Co-Author: Nothing to Disclose

The phalanges and metacarpals are the most common fractures of the skeletal system accounting for 10% of all bony injuries. Despite the use of computed tomography, fractures can sometimes be hard to identify particularly in the presence of osteopenia. Evaluation of bone marrow oedema following hand trauma can increase confidence in fracture identification as it is felt to reflect oedema/haemorrhage. The purpose of this study was to assess bone marrow oedema associated with proven hand fractures on Dual-energy CT using the new colour Siemens DE Bone marrow application against the current virtual non calcium marrow oedema application.

40 consecutive patients underwent dual-energy wrist computed tomography (DECT) studies in the emergency department in 2013. Retrospective evaluation for bone marrow oedema was performed on the Siemens virtual non calcium (VNC) and new DE bone marrow (DE BM) applications by two experienced MSK radiologists. Their confidence on identifying oedema at the known fracture site was documented.

57 fractures were identified with the majority of fractures present within the carpus: 12 scaphoid, 15 triquetral, 2 capitate, 2 hamate, 2 trapezium. There were 6 distal radial and 2 ulnar styloid fractures, with the remaining fractures identified at the base of the metacarpals. Reader 1 using VNC had a Sensitivity 79% (CI 0.66 - 0.89, PPV 97% CI 0.88 - 0.99), Reader 2 VNC - Sensitivity 62% (CI 0.48 - 0.75, PPV 97% CI 0.85 - 0.99). Reader 1 using the DE BM Sensitivity 58% (CI 0.44 - 0.71, PPV 97% CI 0.85 - 0.99), Reader 2 DE BM - Sensitivity 62% (CI 0.48 - 0.75, PPV 97% CI 0.85 - 0.99). The kappa inter-rater reliability between the readers using VNC - 0.277 p=0.021 and DE BM 0.496 p<0.001. The readers confidence for identifying marrow oedema when present, was high when using both applications.

The present of bone marrow oedema can increase the confidence of identifying hand fractures in the acute trauma setting. The DE Bone Marrow application with colour overlay is a valuable imaging tool when MRI is not available .

The presence of bone marrow oedema identified on Dual energy CT can increase the confidence in identifying acute hand fractures in the Emergency Department.

Rajayogeswaran, B, Chhaya, N, McLaughlin, P, Nicolaou, S, Ouellette, H, 'A touch of colour': DE Bone Marrow v Virtual Non-Calcium Application for the Assessment of Bone Marrow Oedema in Acute Hand Fractures.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009000.html