Usefulness of Gadolinium-Enhanced MR Imaging in the Evaluation of the  Vascularity of Scaphoid Nonunions

Cerezal, Luís; Abascal, Faustino; Canga, Ana; García-Valtuille, Roberto; Bustamante, Mario; Piñal, Francisco del

doi:10.2214/ajr.174.1.1740141

Cited by 140 publications

(134 citation statements)

References 32 publications

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“…In our series, on preoperative images there was evidence of an increase in signal intensity after contrast administration in 6 patients, with a marked increase in signal intensity in 3 of these patients (Fig. 4) in the proximal pole of the scaphoid, which according to the current literature [11] should be evidence of bone marrow viability. However, this was not the case as these 3 cases were avascular with no evidence of punctate bleeding intraoperatively.…”

Section: Discussionsupporting

confidence: 64%

“…In stage III, which represented AVN, there was no contrast enhancement. In 2000 Cerezal et al advocated the use of preoperative contrast enhancement to quantify the extent of necrosis of the proximal pole, stating that lack of contrast strongly correlated with AVN and that contrast enhancement showed good correlation with surgical and histological findings with a positive vascular status of the proximal pole of the scaphoid and good healing potential of the pseudoarthrosis [11]. In our series, on preoperative images there was evidence of an increase in signal intensity after contrast administration in 6 patients, with a marked increase in signal intensity in 3 of these patients (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Scapholunate ligaments were intact and confirmed at surgery. This may possibly allow for intact collateral vascular supply to the proximal pole of the scaphoid [11] and therefore we recommend review for scapholunate ligament status on preoperative MR imaging.…”

Section: Discussionmentioning

confidence: 99%

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MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

et al. 2005

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Objective: To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard. Design and patients: A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20-38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients. Results: Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%). Conclusions: MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

et al. 2005

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“…Unenhanced MR examination included a coronal and sagittal T1-weighted spin-echo sequence; a coronal intermediate-weighted, turbo spin-echo sequence with fat saturation; and a transverse true fast imaging with steady-state precession sequence. Dynamic gadolinium-enhanced MR imaging was performed after intravenous administration of 10 mL of a gadolinium chelate (Gadovist 1.0; Bayer [Schweiz], viability of the scaphoid aids in the preoperative planning of the most appropriate grafting procedure (eg, vascularized vs nonvascularized bone graft) and in predicting the healing capacity of a fracture ( 9 ). The purpose of our study was to compare the accuracy of dynamic gadolinium-enhanced MR imaging with that of standard MR imaging for assessing the viability of the proximal pole of the scaphoid in patients with nonunion.…”

Section: Mr Imaging Protocolmentioning

confidence: 99%

Is Dynamic Gadolinium Enhancement Needed in MR Imaging for the Preoperative Assessment of Scaphoidal Viability in Patients with Scaphoid Nonunion?

Donati¹,

Zanetti²,

Nagy³

et al. 2011

Radiology

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rrmann , MD Purpose:To compare the accuracy of dynamic gadolinium-enhanced magnetic resonance (MR) imaging with that of standard MR imaging for assessing the viability of the proximal pole of the scaphoid in patients with nonunion. Materials and Methods:The study protocol was submitted to the institutional review board, and the need to obtain additional approval was waived for this retrospective study. Twenty-eight patients (mean age 6 standard deviation, 24.3 years 6 6.4) with nonunion of a scaphoid fracture underwent dynamic gadolinium-enhanced MR imaging of the wrist 28 days 6 19 before surgery. Dynamic gadolinium-enhanced MR imaging consisted of acquisition of 40 consecutive coronal T1-weighted images over 1 minute. Two readers retrospectively evaluated MR images obtained with a standard protocol and rated the viability of the proximal scaphoid pole. The steepest upslope of gadolinium uptake was calculated in a region of interest placed in the proximal scaphoid pole by a third reader. Receiver operating characteristic curves were calculated, and the areas under the receiver operating characteristic curve ( A z values) were compared. Diagnostic performance in determining scaphoid viability was calculated for readers 1 and 2. Histologic fi ndings in 11 patients and surgical fi ndings in all patients served as the standard of reference. Results:The sensitivity, specifi city, and accuracy of standard MR imaging in the detection of scaphoid necrosis were 54%, 93%, and 75%, respectively, for reader 1 and 62%, 93%, and 78% for reader 2. Interreader reliability was excellent ( k = 0.92). The A z was 0.82 for reader 1 and 0.87 for reader 2. The diagnostic performance of dynamic gadolinium-enhanced MR imaging, determined with the steepest upslope value, was inferior to that of standard MR imaging, with an A z of 0.57. Findings at histologic examination (viable bone, necrotic bone, callus formation) did not correlate with those at dynamic gadolinium-enhanced MR imaging. Conclusion:Because the diagnostic performance of dynamic gadoliniumenhanced MR imaging in the evaluation of scaphoid viability was inferior to that of a standard MR imaging protocol, dynamic acquisition may not be needed in patients with nonunion of scaphoid fractures.q RSNA, 2011

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“…MRI might be the most accurate, but it is not infallible [16]. Diagnostic confirmation, however, is possible only with a histological examination [17].…”

Section: Introductionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to correlate the preoperative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.

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Usefulness of Gadolinium-Enhanced MR Imaging in the Evaluation of the Vascularity of Scaphoid Nonunions

Abstract: Gadolinium-enhanced MR imaging is the most reliable imaging method for investigating the vascularity of the proximal pole in scaphoid nonunions.

Cited by 140 publications

References 32 publications

MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

Is Dynamic Gadolinium Enhancement Needed in MR Imaging for the Preoperative Assessment of Scaphoidal Viability in Patients with Scaphoid Nonunion?

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

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