The feasibility of high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with suspected scaphoid fractures

M.S.A.M. Bevers, A.M. Daniels, C.E. Wyers, Bert van Rietbergen, P.P.M.M. Geusens, S. Kaarsemaker, H.M.J. Janzing, P.F.W. Hannemann, M. Poeze, Joop P.W. van den Bergh (Corresponding author)

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)


Introduction: Diagnosing scaphoid fractures remains challenging. High-resolution peripheral quantitative computed tomography (HR-pQCT) might be a potential imaging technique, but no data are available on its feasibility to scan the scaphoid bone in vivo. Methodology: Patients (≥18 years) with a clinically suspected scaphoid fracture received an HR-pQCT scan of the scaphoid bone (three 10.2-mm stacks, 61-μm voxel size) with their wrist immobilized with a cast. Scan quality assessment and bone contouring were performed using methods originally developed for HR-pQCT scans of radius and tibia. The contouring algorithm was applied on coarse hand-drawn pre-contours of the scaphoid bone, and the resulting contours (AUTO) were manually corrected (sAUTO) when visually deviating from bone margins. Standard morphologic analyses were performed on the AUTO- and sAUTO-contoured bones. Results: Ninety-one patients were scanned. Two out of the first five scans were repeated due to poor scan quality (40%) based on standard quality assessment during scanning, which decreased to three out of the next 86 scans (3.5%) when using an additional thumb cast. Nevertheless, after excluding one scan with an incompletely scanned scaphoid bone, post hoc grading revealed a poor quality in 14.9% of the stacks and 32.9% of the scans in the remaining 85 patients. After excluding two scans with contouring problems due to scan quality, bone indices obtained by AUTO- and sAUTO-contouring were compared in 83 scans. All AUTO-contours were manually corrected, resulting in significant but small differences in densitometric and trabecular indices (<1.0%). Conclusions: In vivo HR-pQCT scanning of the scaphoid bone is feasible in patients with a clinically suspected scaphoid fracture when using a cast with thumb part. The proportion of poor-quality stacks is similar to radius scans, and AUTO-contouring appears appropriate in good- and poor-quality scans. Thus, HR-pQCT may be promising for diagnosis of and microarchitectural evaluations in suspected scaphoid fractures.

Original languageEnglish
Pages (from-to)432-442
Number of pages11
JournalJournal of Clinical Densitometry
Issue number3
Early online date16 Aug 2019
Publication statusPublished - 1 Jul 2020


  • automatic contouring algorithm
  • high-resolution peripheral quantitative computed tomography
  • in vivo imaging
  • scan quality
  • scaphoid fracture


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