Role of Magnetic Resonance Imaging in Assessing Factors Affecting Healing in Scaphoid Nonunions

Morgan, William J.; Breen, Thomas F.; Coumas, James M.; Schulz, Lisa A.

doi:10.1097/00003086-199703000-00032

Cited by 35 publications

(21 citation statements)

References 12 publications

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“…In case of nonviability of the proximal scaphoid pole, a vascularized rather than a standard nonvascularized bone graft is preferred by the treating surgeon ( 27,28 ). In recent years, gadolinium-enhanced MR imaging has become the standard imaging method for the assessment of scaphoid viability ( 9,29,30 ).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Morgan et al evaluated the significance and role of magnetic resonance imaging in assessing factors affecting healing in scaphoid non-unions [7]. There were three groups that were delineated in the study with respect to scaphoid non-unions.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Spontaneous Healing of a Proximal Pole Scaphoid Non-Union

Park

Lee

Yao

2011

Hand (New York, N,Y.)

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“…Preoperative radiographs, CT and bone scintigraphy are not accurate in assessing AVN [35,40]. In contrast, several reports suggest MRI as the most sensitive non-invasive modality to assess vascularity of both segments of the scaphoid preoperatively either without [35,39,48,49] or with [40][41][42] gadolinium administration. It has been suggested that low signal intensity of the proximal pole on T1-w and T2-w images is and contrast-enhanced fat-suppressed T1-w (b) images in a 30-year-old man with previous scaphoid nonunion show low signal intensity of the graft and enhancement, respectively (short thick arrow), located between the normal signal intensity distal pole (arrow) and the low signal intensity proximal pole (thin arrow).…”

Section: Treatment Planning and Postoperative Evaluation Of Vascularimentioning

confidence: 99%

“…Green reported a union rate of 92% when bleeding of the proximal pole was observed intraoperatively versus 0% when the proximal pole was ischemic [38]. Many recent studies provide data to support the use of MRI for the assessment of vascularity of both segments of the scaphoid to obtain predictive information [39][40][41][42][43].…”

Section: Fracture Healing Nonunion and Proximal Pole Necrosismentioning

confidence: 99%

The role of MR imaging in scaphoid disorders

2007

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The scaphoid bone of the wrist is one of the most commonly fractured bones in the body. Due to its importance in the biomechanics and functionality of the wrist, it is important to depict and characterize the type of injury. Plain radiographs and scintigraphy may fail to disclose the type and severity of the injury. In patients with normal initial plain radiographs, MR imaging can discriminate occult fractures from bone bruises and may also demonstrate ligamentous disruption. MR imaging can also discriminate the proximal pole viability versus avascular necrosis secondary to previous fracture, which is important for treatment planning. Treatment of non-united fractures with vascularized grafts can be evaluated with contrast-enhanced MR imaging. Idiopathic osteonecrosis or Preiser's disease was originally described after trauma. The non-traumatic disorders of the scaphoid include post-traumatic osteoarthritis, inflammatory bone marrow edema in patients with rheumatoid arthritis, and osteomyelitis. MR imaging is helpful in all the above disorders to demonstrate early bone marrow edema, cartilage degeneration and associated subchondral marrow changes. The most commonly found tumors in the scaphoid are usually benign and include enchondroma, osteoblastoma and osteoid osteoma. MR imaging is not mandatory for the initial diagnosis, which should be based on plain X-ray findings.

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Role of Magnetic Resonance Imaging in Assessing Factors Affecting Healing in Scaphoid Nonunions

Cited by 35 publications

References 12 publications

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

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

An Unusual Case of Spontaneous Healing of a Proximal Pole Scaphoid Non-Union

The role of MR imaging in scaphoid disorders

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