MRI detection of radiographically occult fractures of the hip and pelvis in the elderly: Comparison of T2-weighted Dixon sequence with T1-weighted and STIR sequences.
(2019) Diagnostic & Interventional Imaging — Vol. 100, n° 3, p. 169-175 (2019)
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- PURPOSE: To compare the diagnostic performance of T2-weighted Dixon, T1-weighted and Short-Tau Inversion Recovery (STIR) MR images for the detection of radiographically occult fractures (ROF) of the hip and pelvis in elderly patients after low-energy trauma. MATERIALS AND METHODS: A total of 22 patients older than 50 years with suspected ROF after low-energy trauma was prospectively included. There were 9 men and 13 women, with a mean age of 80.9 years±12.5 (SD) (range: 52-100 years). T2-weighted Dixon, T1-weighted and STIR MR images were analyzed by 3 independent radiologists blinded to the clinical data and the results of other imaging examinations. Readers separately assessed each series of images for the presence of fractures on a per bone analysis. Diagnostic performance of each reader was compared for Dixon and non-Dixon sequences using contingency tables and McNemar test. Interobserver agreement was evaluated according to the Fleiss-Cuzick's kappa statistics. RESULTS: The sensitivity of the Dixon sequence in the detection of ROF ranged from 90.9% (20/22; 95% CI: 70.8-98.9%) to 100% (22/22; 95% CI: 84.6-100%). The sensitivities of the non-Dixon sequences in the detection of ROF ranged from 95.5% (21/22; 95% CI: 77.2-99.9%) to 100% (22/22; 95% CI: 84.6-100%). For each reader, there were no statistical differences between combined Dixon and combined non-Dixon images for the detection of ROF (P=0.12, 0.99 and 0.99). Interobserver agreement with T2-weighted Dixon water-only images was significantly lower than that with the STIR sequence (0.70-0.79 vs. 0.87-0.93). CONCLUSION: T2-weighted Dixon may be a second-rate alternative to T1-weighted and STIR sequences for the detection of ROF of the hip and pelvis in elderly patients.
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Heynen, B., Tamigneaux, C., Pasoglou, V., Malghem, J., Vande Berg, B., & Kirchgesner, T. (2019). MRI detection of radiographically occult fractures of the hip and pelvis in the elderly: Comparison of T2-weighted Dixon sequence with T1-weighted and STIR sequences. Diagnostic & Interventional Imaging, 100(3), 169-175. https://doi.org/10.1016/j.diii.2018.11.008 (Original work published 2019)