Spectral computer-tomography and the ability to detect occult femoral neck and scaphoid fractures – A systematic review and exploratory meta-analysis

Objective

This systematic review aims to describe the ability of spectral computed tomography (SCT) to identify bone marrow oedema (BME) in the scaphoid bone and the femoral neck compared to magnetic resonance images (MRI).

Materials and methods

PubMed, Embase and Cochrane Library were searched from the 1st of October 2024; eligible studies had patients over 15 years of age, underwent SCT and had MRI as a gold standard. Sensitivities, specificities, negative predictive values (NPV) and positive predictive values (PPV) were noted or calculated from available information. Bias and applicability were assessed using QUADAS-2 tools. A random-effects model was used in the meta-analysis, and heterogeneity was assessed using I² statistics.

Results

1061 studies were identified and screened by title/abstract. Twenty-two studies underwent full-text assessment. A total of four were included, of which three were suitable for meta-analysis regarding the scaphoid bone. Pooled sensitivity was 93 %, specificity was 98 %, PPV was 92 % and NPV was 98 %. A single study concerning the femoral neck was located, with sensitivity, specificity, PPV and NPV of 87 %, 94 %, 93 % and 89 % respectively.

Conclusions

Data regarding the ability of SCT to detect BME in the femoral neck and scaphoid bone are promising, but limited, with only small studies available. There is a need for larger prospective studies, regarding both the detection of occult fractures in the femoral neck and the scaphoid bone.