Share：
Share this content in WeChat
X
[Chinese][PDF]84136
• Experience Exchanges •
The diagnostic value of magnetic resonance imaging in rib micro-fractures
ZHANG Tao  WANG Shuwen  CHEN Yuchen  MAO Cunnan  WU Jing  WU Xinying  YIN Xindao  LU Lingquan 

Cite this article as: Zhang T, Wang SW, Chen YC, et al. The diagnostic value of magnetic resonance imaging in rib micro-fractures[J]. Chin J Magn Reson Imaging, 2022, 13(3): 87-90, 92. DOI:10.12015/issn.1674-8034.2022.03.018.


[Abstract] Objective To explore the value of MRI in the diagnosis of rib micro-fractures through a comparative study of MRI and CT.Materials and Methods Twenty-five patients with mild chest trauma admitted to our hospital from February 2019 to December 2020 were recruited. The patients were subjected to CT and MRI within three weeks after the trauma, CT rescanning was scheduled 4-8 weeks later to classify rib fractures and determine the diagnostic accuracy and sensitivity of MRI and CT for rib micro-fractures. Fisher's exact probability method was used to test the difference between MRI and first CT.Results The rib micro-fractures were divided into two types. Type Ⅰ rib fractures showed cortical fracture with callus formation, whereas type Ⅱ had an intact cortical bone with intraosseous callus formation. Type Ⅰ fracture showed bone marrow edema with subperiosteal effusion in MRI, whereas type Ⅱ showed bone marrow edema without subperiosteal effusion. Ninety-one rib micro-fractures were confirmed by CT rescanning, of which 86 (94.51%) were type Ⅰ fractures and 5 (5.49%) were type Ⅱ. MRI identified 90 fractures, of which 3 were false positive, with the diagnostic accuracy rate of 92.55% and sensitivity rate of 95.60%. Among them, type Ⅰ fractures (n=85, 3 were false positive) showed "sandwich" sign (heterogeneous high-signal shadow within bone marrow of the inner layer, low-signal bony cortex of the middle layer, and high-signal subperiosteal effusion of the outer layer) in fat pressing sequences; type Ⅱ fractures (n=5) displayed intramedullar high-signal intensities and no subperiosteal effusion. Fifty-five fractures (all type Ⅰ) were discovered in the initial CT examination, and corresponding diagnostic accuracy rate and sensitivity rate were 60.44%. There was significant difference in the number of fractures detected by MRI and initial CT (P=0.027).Conclusions MRI has high sensitivity and accuracy in the diagnosis of rib micro-fractures, so it can be used as a routine supplementary examination besides CT for patients with mild chest trauma.
[Keywords] magnetic resonance imaging；computed tomography；rib fracture；oblique-axial；diagnostic value

ZHANG Tao   WANG Shuwen   CHEN Yuchen   MAO Cunnan   WU Jing   WU Xinying   YIN Xindao   LU Lingquan*  

Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

Lu LQ, E-mail: njllq333@sina.com

Conflicts of interest   None.

Received  2021-09-03
Accepted  2022-03-01
DOI: 10.12015/issn.1674-8034.2022.03.018
Cite this article as: Zhang T, Wang SW, Chen YC, et al. The diagnostic value of magnetic resonance imaging in rib micro-fractures[J]. Chin J Magn Reson Imaging, 2022, 13(3): 87-90, 92. DOI:10.12015/issn.1674-8034.2022.03.018.

[1]
Henry TS, Donnelly EF, Boiselle PM, et al. ACR appropriateness criteria® rib fractures[J]. J Am Coll Radiol, 2019, 16(5): S227-S234. DOI: 10.1016/j.jacr.2019.02.019.
[2]
Bemelman M, Baal MV, Raaijmakers C, et al. An interobserver agreement study with a new classification for rib fractures[J]. Chirurgia (Bucur), 2019, 114(3): 352-358. DOI: 10.21614/chirurgia.114.3.352.
[3]
Singleton JM, Bilello LA, Canham LS, et al. Chest computed tomography imaging utility for radiographically occult rib fractures in elderly fall-injured patients[J]. J Trauma Acute Care Surg, 2019, 86(5): 838-843. DOI: 10.1097/TA.0000000000002208.
[4]
Jin L, Ge XJ, Lu F, et al. Low-dose CT examination for rib fracture evaluation: a pilot study[J]. Medicine, 2018, 97(30): e11624. DOI: 10.1097/MD.0000000000011624.
[5]
Shelmerdine SC, Langan, Hutchinson JC, et al. Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study[J]. Lancet Child Adolesc Health, 2018, 2(11): 802-811. DOI: 10.1016/S2352-4642(18)30274-8.
[6]
Yang L, Pu H, Zhu Y. Clinical application of MSCT scan and 3D reconstruction in reducing the missed diagnosis rate of occult fractures[J]. Chin J CT & MRI, 2017, 15(7): 137-140. DOI: 10.3969/j.issn.1672-5131.2017.07.043.
[7]
Park JB, Cho YS, Choi HJ. Diagnostic accuracy of the inverted grayscale rib series for detection of rib fracture in minor chest trauma[J]. Am J Emerg Med, 2015, 33(4): 548-552. DOI: 10.1016/j.ajem.2015.01.015.
[8]
Baker JC, Hoover EG, Hillen TJ, et al. Subradiographic foot and ankle fractures and bone contusions detected by MRI in elite ice hockey players[J]. Am J Sports Med, 2016, 44(5): 1317-1323. DOI: 10.1177/0363546515626181.
[9]
Gil H, Tuttle AA, Dean LA, et al. Dedicated MRI in the emergency department to expedite diagnostic management of hip fracture[J]. Emerg Radiol, 2020, 27(1): 41-44. DOI: 10.1007/s10140-019-01729-5.
[10]
Subhas N, Kline MJ, Moskal MJ, et al. MRI evaluation of costal cartilage injuries[J]. AJR Am J Roentgenol, 2008, 191(1): 129-132. DOI: 10.2214/AJR.07.3396.
[11]
Marcussen B, Negaard M, Hosey RG, et al. A case series and literature review: isolated traumatic first rib fracture in Athletes[J]. Clin J Sport Med, 2020, 30(3): 257-266. DOI: 10.1097/JSM.0000000000000614.
[12]
Wang SL, Wang LS, Sun DY, et al. The value of multislice helical CT in the diagnosis of the rib micro-fracture[J]. Chin J Radiol, 2005(12): 1289-1292.
[13]
Cho SH, Sung YM, Kim MS. Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT[J]. Br J Radiol, 2012, 85(1018): e845-e850. DOI: 10.1259/bjr/28575455.
[14]
Wang F, Lu LQ. Discussion on the best time of CT oblique oblique-axial reconstruction in the identification of rib micro-fracture[J]. Acta Univ Med Nanjing Nat Sci, 2018, 38(1): 122-124.
[15]
Pedersen DR, El-Khoury GY, Thedens DR, et al. Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity[J]. Open Access J Sports Med, 2017, 8: 9-15. DOI: 10.2147/OAJSM.S118811.
[16]
Li YX, Xiang JY, Ling XL, et al. The value of VR, CPR reconstruction technique of MSCT in subtle rib fracture diagnosis[J]. Chin J Med Imaging, 2013, 23(1): 110-112. DOI: 10.3969/j.issn.1006-9011.2013.01.039.
[17]
Karantanas AH. What's new in the use of MRI in the orthopaedic trauma patient?[J]. Injury, 2014, 45(6): 923-933. DOI: 10.1016/j.injury.2014.01.012.
[18]
Haubro M, Stougaard C, Torfing T, et al. Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur[J]. Injury, 2015, 46(8): 1557-1561. DOI: 10.1016/j.injury.2015.05.006.
[19]
Heynen B, Tamigneaux C, Pasoglou V, et al. 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[J]. Diagn Interv Imaging, 2019, 100(3): 169-175. DOI: 10.1016/j.diii.2018.11.008.
[20]
Lu LQ, Xu MS, Wu QZ, et al. The value of MR imaging of PDFASAT sequence in the diagnosis of extremities occult fractures[J]. Chin J Radiol, 2004, 38(12): 1324-1328. DOI: 10.3760/j.issn:1005-1201.2004.12.023.
[21]
Khurana B, Okanobo H, Ossiani M, et al. Abbreviated MRI for patients presenting to the emergency department with hip pain[J]. AJR Am J Roentgenol, 2012, 198(6): W581-W588. DOI: 10.2214/AJR.11.7258.

PREV The diagnostic value of short T1 signal and ADC value in benign and malignant ovarian lesions
NEXT Cranionasal communicative schwannoma: One case report
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn