Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images.

To assess the diagnostic efficacy of T1-weighted magnetic resonance (MR) images when findings on radiographs of the hip are indeterminate, 20 patients with suspected hip fracture and indeterminate radiographs were prospectively evaluated. MR imaging was performed with surface coil technique; one coronal T1-weighted (repetition time msec/echo time msec = 400/19) MR image was obtained. The total charge for the examination was $448 (compared with the following usual charges: radionuclide bone scan, $455; tomography, $299; and computed tomography, $797). When MR imaging and clinical outcome were used as the standard of reference, the prospective accuracy of MR imaging in diagnosis of the presence or absence of hip fracture was 100% (20 correct diagnoses). All MR studies were diagnostic. Of the 13 patients with fracture (eight with trochanteric and five with subcapital fracture), 10 patients (77%) underwent surgery and three patients (23%) received conservative treatment. T1-weighted MR images can enable diagnosis or exclusion of hip fracture whenever radiographs are indeterminate. The imaging time is approximately 7 minutes, and the cost of the examination can be made competitive with costs of other advanced imaging examinations.