| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Correspondence |
Drs Brydie and Raby [1] make a compelling argument for the value of early MRI in the management of scaphoid fractures. However, their discussion of diagnostic "gold standards" in this condition would do credit to a street magician.
They point out that for investigating clinical scaphoid fractures, "plain radiographs [including delayed films] have been the gold standard to date". However, they do not tell us how many of their 195 patients in whom a clinical scaphoid fracture was not visible on initial radiographs, delayed radiographs actually confirmed the diagnosis, i.e. how many of the MRI positives were confirmed by the existing gold standard? We are not given the number of the false positive MRIs, nor the number of false negatives, relative to what the authors have stated is the "existing gold standard".
In discussion, the authors point out that bone scintigraphy has "high sensitivity for fracture, but poor specificity with a false positive rate of 25% when compared with delayed radiographs". How does it come about that when the radionuclide procedure is more sensitive than delayed radiographs, it is because of false positive nuclear medicine studies, whilst when MRI is more sensitive (probably – although data weren't included in the authors' paper) the argument is that the apparently more sensitive test should become the new gold standard? A more balanced view would strengthen the authors' case.
Yours etc.,
Department of Clinical Radiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
Received for publication July 4, 2003. Accepted for publication September 10, 2003.
References
Related articles in BJR:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| BJR | DMFR | IMAGING | ALL BIR JOURNALS |
