Discrepancies between radiography and magnetic resonance imaging in acute wrist trauma among women aged 50 years and older: A prospective exploratory study

Objectives: The objectives of the study are to describe traumatic wrist findings on conventional radiographs and supplemental magnetic resonance imaging (MRI) in women aged 50 years or older with acute wrist trauma. The main focus was to describe discrepancies between radiography and MRI, including radiograph-negative MRI findings, additional or differently located fracture sites, and MRI characterization of intra-articular involvement. Material and Methods: This prospective, single-center exploratory paired imaging study included 50 women aged 50 years or older referred to the emergency department with acute wrist trauma and clinical suspicion of wrist fracture. All patients underwent standard wrist radiography followed by MRI within 3 h. Radiographs and MRI examinations were evaluated independently. MRI was used for comparison with radiography and not as an independent reference standard. Imaging findings were categorized as concordant findings, radiograph-negative MRI findings, additional MRI findings, or differences in fracture characterization. Results: Mean patient age was 67.7 ± 11.5 years (range 50–95 years). Radiographs demonstrated traumatic abnormalities in 31 of 50 patients (62%), whereas MRI demonstrated traumatic findings in 40 of 50 patients (80%). Radiography and MRI were concordant for the presence or absence of any traumatic finding in 39 patients: 30 patients had traumatic findings on both modalities, and 9 patients had no traumatic finding on either modality. Discordant findings occurred in 11 patients, including 10 radiograph-negative MRI-positive cases and one radiograph-positive MRI-negative case. Radiograph-negative MRI-positive traumatic findings were present in 10 patients (20%) and included fractures, bone bruises, and soft-tissue injuries. MRI identified additional or differently located fractures in 9 patients (18%) and demonstrated intra-articular involvement or clearer intra- articular fracture characterization in 15 patients (30%). Six patients (12%) had scaphoid fractures on MRI. Conclusion: Supplemental MRI demonstrated additional traumatic findings and provided further fracture characterization compared with initial radiography in women aged 50 years or older with acute wrist trauma. The added value was mainly related to radiograph-negative MRI findings, additional fracture sites, and intra-articular involvement. These findings support the selective use of MRI as a supplemental imaging tool when radiographs are negative, equivocal, or insufficient for fracture characterization.