Idiopathic osteonecrosis of the scaphoid (Preiser's disease) – MRI gives new insights into etiology and pathology

Osteonecrosis of the Upper Extremity: MRI-Based Zonal Patterns and Differential Diagnosis

“…the mentioned three-zone model in osteonecrosis. 19,20,43 From a pathoanatomical perspective, the repair zone is characterized by the existence of hyperemia, regional osteopenia, and insufficiency fractures.…”

“…Quantification of bone marrow relaxivity before and after administration of gadolinium-based contrast media hints at the state of bone metabolism in different areas. 18,20,25,43 For visualization of osteosclerosis and other subtle radiography findings (resorption zones, insufficiency fractures, initial osteoarthritis), high-resolution computed tomography (HRCT) is considered the reference standard. Therefore, comprehensive imaging analysis in carpal osteonecrosis should always consist of synoptical use of radiography, HRCT, and ceMRI.…”

“…Diagnostic imaging: Corresponding to MRI findings in Kienböck's disease, we found the same three-layered composition of necrosis, repair zone, and viable bone tissue in our patient population with Preiser's disease. 43 Osteonecrosis is located primarily at the proximal pole with adjoining hypervascular repair tissue, whereas the distal segment of the scaphoid is composed of viable osseous tissue.…”

“…Early stages of idiopathic osteonecrosis are characterized by osteosclerosis and signal alterations in MRI 41,43 while the scaphoid's shape remains intact. In later stages, however, the proximal pole of the scaphoid displays a progressive conical deformation ("nipple sign") and in some cases insufficiency fractures.…”

Atraumatic Osteonecrosis of the Distal Radius and Ulna: Case Series and Review

“…Multifocal osteonecrosis is defined by the occurrence of atraumatic osteonecrosis in 3 or more sites; reports have described risk factors, comorbidities, and efforts to determine patterns of affected sites in this unusual disease. 24 -26 Several citations explore the etiology, diagnosis, and treatment of osteonecrosis of the scaphoid, [27][28][29][30][31][32] capitate, [33][34][35][36][37][38][39][40] and lunate, [41][42][43][44][45] as well as multifocal disease affecting the metacarpals and various carpals. 46 -49 The purposes of this report were to assess the characteristics of osteonecrosis in the distal ulna, radius, or both; to identify common risk factors; and to evaluate the success of treatment by percutaneous drilling.…”