Diagnostic performance of a computed tomography (CT)-like 3D- multiecho fast field echo (mFFE) magnetic resonance imaging (MRI) sequence for acute wrist fractures: comparison with cone-beam computed tomography (CT)

AIM: Accurate detection and characterizstion of wrist fractures are essential for optimal management of wrist trauma. This study aimed to evaluate the diagnostic performance of a computed tomography (CT)-like 3D-multiecho fast field echo (mFFE) magnetic resonance imaging (MRI) sequence for the detection and morphological characterisation of traumatic wrist fractures compared with cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective study included 66 patients with recent wrist trauma and suspected fracture between October 2022 and September 2023. Two musculoskeletal radiologists (R1 and R2) independently reviewed CBCT and 3D-mFFE CT-like MRI images. The diagnostic performance of the 3D-mFFE sequence for detecting and characterising traumatic bone injuries was assessed using a consensus interpretation by a third radiologist (R3) as the reference standard. RESULTS: Sixty-three traumatic bone injuries were identified in 38 of the 66 patients (58%). For injury detection with the 3D-mFFE sequence, sensitivity, specificity, and accuracy were 0.62, 0.99, and 0.96 for R1 and 0.60, 1.00, and 0.96 for R2. For CBCT, sensitivity, specificity, and accuracy were 0.68, 1.00, and 0.97 for R1 and 0.70, 1.00, and 0.97 for R2. Agreement between the 3D-mFFE sequence and the reference standard for fracture characterisation was strong to near perfect for both comminution (κ = 0.69-0.87) and displacement (κ = 0.63-0.92). CONCLUSION: The CT-like 3D-mFFE MRI sequence demonstrated diagnostic performance comparable to CBCT for the morphological assessment of wrist fractures. When incorporated into a standard MRI protocol, this sequence may allow both detection and characterisation of traumatic bone injuries within a single, radiation-free examination.