Kienböck Disease: Moving Forward

Lichtman, David M.; Pientka, William F.; Bain, Gregory I.

doi:10.1016/j.jhsa.2016.02.013

Cited by 50 publications

(42 citation statements)

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“…Patient number 1 with Kienböck's disease Stage IIIb, and a long history of pain in the wrist: (a) Histological specimen with histological overview of transected lunate magnification of trabecular bone necrosis , and magnification of interface between fracture and bone with new bone formation . (b) DCE‐MR analysis in sagittal plane, ROIs were placed in different areas.…”

Section: Resultsmentioning

confidence: 99%

“…KIENBÖCK'S DISEASE, or osteonecrosis of the lunate, is a progressive disease that can lead to joint destruction and pain. Although described more than 100 years ago, the precise etiology, the natural history, and the optimal diagnostics and treatment are still not clear . Patients usually present with a history of wrist pain without previous trauma.…”

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

“…Radiographs can detect sclerosis, cystic changes, fragmentation and collapse, and also osteoarthritic changes. However, most of these findings indicate advanced disease stages requiring complicated surgical interventions or salvage operations . Furthermore, it should be kept in mind that the morphology on radiographs does not always correlate with symptoms …”

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

“…The basic abnormality of Kienböck's disease is thought to be an impaired vascular supply to the lunate . Thus, a diagnostic modality capable of assessing vascularity in the lunate would probably improve both the diagnostic capability and the possibility of monitoring the effects of different treatment regimes.…”

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

“…However, most of these findings indicate advanced disease stages requiring complicated surgical interventions or salvage operations. 3 Furthermore, it should be kept in mind that the morphology on radiographs does not always correlate with symptoms. 2,3 As magnetic resonance imaging (MRI) became more widely available, the Lichtman classification was modified to include a stage 1, where radiographs are normal but MRI shows reduced signal intensity in the lunate on T 1 -weighted images ( Table 1).…”

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Increased perfusion in dynamic gadolinium‐enhanced MRI correlates with areas of bone repair and of bone necrosis in patients with Kienböck's disease

Müller

Månsson

Müller

et al. 2018

Magnetic Resonance Imaging

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Background Osteonecrosis of the lunate, Kienböck's disease, can lead to fragmentation of the lunate, carpal collapse, and severe osteoarthritis. Since the etiology of Kienböck's disease is impaired circulation, a diagnostic method capable of assessing perfusion would be valuable. Recent studies have suggested that dynamic contrast‐enhanced (DCE) MR examinations at 3 T can assess perfusion in healthy carpal bones. Purpose To evaluate the use of DCE‐MR for assessing perfusion in the lunate bone in patients with Kienböck's disease. Furthermore, to compare perfusion with histopathology with a focus on bone viability. Study Type Prospective case–control study. Population Fourteen patients with Kienböck's disease and a control group of 19 healthy subjects. Field Strength: 3 T with T1‐weighted fat‐saturated contrast‐enhanced gradient echo series. Assessment Features of the enhancement curves from the DCE‐MR examinations, time to peak (TTP), maximum slope (MS), and maximum enhancement (ME) assessed by a radiologist. Six of 14 patients were surgerized with lunate excision, allowing comparison between features of the enhancement curves and histopathology. Statistical Tests Mann–Whitney U‐test. P < 0.05 was considered a statistically significant difference. Results Patients with Kienböck's disease showed significantly higher and faster perfusion parameters compared with the control group, the mean value of the TTP in patients was 126.73 sec, in controls 189.79 sec (P = 0.024), ME in patients 173.55 AU, in controls 28.46 AU (P < 0.001), and MS in patients 5.04 AU, in controls 1.06 AU (P < 0.001). When compared with histopathology, increased perfusion was seen in areas of bone formation but also in necrosis. Areas of normal bone showed low perfusion. Data Conclusion DCE‐MRI at 3 T can diagnose altered perfusion in patients with Kienböck's disease. Increased perfusion cannot definitely be used as a marker of bone viability. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:481–489.

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Section: Resultsmentioning

confidence: 99%

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

Section: Lichtman Classification Of Kienböck's Disease (Adapted From mentioning

confidence: 99%

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confidence: 99%

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