Abstract
Objective
To evaluate the usefulness of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) for assessing the viability of the proximal pole of the scaphoid in patients with acute scaphoid fractures.
Methods
Eighteen consecutive patients with acute scaphoid fracture who underwent dynamic gadolinium-enhanced MRI 7 days or less before surgery were prospectively included between August 2011 and December 2012. All patients underwent MR imaging with unenhanced images, enhanced images, and dynamic enhanced images. A radiologist first classified the MRI results as necrotic or viable based on T1- and T2-weighted images only, followed by a second blinded interpretation, this time including analysis of pre- and post-gadolinium administration images and a third blinded interpretation based on the time–intensity curve of the dynamic enhanced study. The standard of reference was the histologic assessment of a cylindrical specimen of the proximal pole obtained during surgery in all patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for unenhanced, enhanced, and dynamic gadolinium-enhanced MRI studies.
Results
The sensitivity, specificity, PPV, and NPV were 67, 67, 50, and 80 % for unenhanced images, 83, 100, 100, and 92 for enhanced images, and 83, 92, 83, and 92 for dynamic contrast-enhanced images.
Conclusions
Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time–intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ottenin MA, Jacquot A, Grospretre O, Noël A, Lecocq S, Louis M, et al. Evaluation of the diagnostic performance of tomosynthesis in fractures of the wrist. AJR Am J Roentgenol. 2012;198(1):180–6.
Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci. 2006;11(4):424–31.
Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CW. Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion? Radiology. 2011;260(3):808–16.
Tambe AD, Cutler L, Stilwell J, Murali SR, Trail IA, Stanley JK. Scaphoid non-union: the role of vascularized grafting in recalcitrant non-unions of the scaphoid. J Hand Surg (Br). 2006;31(2):185–90.
Trumble TE. Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg [Am]. 1990;15(4):557–64.
Singh HP, Taub N, Dias JJ. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies. Injury. 2012;43(6):933–9.
Karantanas A, Dailiana Z, Malizos K. The role of MR imaging in scaphoid disorders. Eur Radiol. 2007;17(11):2860–71.
Cerezal L, Abascal F, Canga A, García-Valtuille R, Bustamante M, del Piñal F. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR Am J Roentgenol. 2000;174(1):141–9.
Sugawara Y, Murase K, Kikuchi K, et al. Measurement of tumor blood flow using dynamic contrast-enhanced magnetic resonance imaging and deconvolution analysis: a preliminary study in musculoskeletal tumors. J Comput Assist Tomogr. 2006;30(6):983–90.
Rosen BR, Belliveau JW, Vevea JM, Brady TJ. Perfusion imaging with NMR contrast agents. Magn Reson Med. 1990;14(2):249–65.
Schmitt R, Christopoulos G, Wagner M, Krimmer H, Fodor S, van Schoonhoven J, et al. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI? Eur J Radiol. 2011;77(2):222–7.
Kulkarni RW, Wollstein R, Tayar R, Citron N. Patterns of healing of scaphoid fractures. The importance of vascularity. J Bone Joint Surg Br. 1999;81(1):85–90.
Desser TS, McCarthy S, Trumble T. Scaphoid fractures and Kienbock’s disease of the lunate: MR imaging with histopathologic correlation. Magn Reson Imaging. 1990;8(4):357–61.
Fox MG, Gaskin CM, Chhabra AB, Anderson MW. Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol. 2010;195(4):W281–6.
Merino JG, Warach S. Imaging of acute stroke. Nat Rev Neurol. 2010;6(10):560–71.
Dyke JP, Aaron RK. Noninvasive methods of measuring bone blood perfusion. Ann N Y Acad Sci. 2010;1192:95–102.
Dawson JS, Martel AL, Davis TR. Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium. J Bone Joint Surg (Br). 2001;83(6):809–14.
Ng AW, Griffith JF, Taljanovic MS, Li A, Tse WL, Ho PC. Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union? Skeletal Radiol. 2013;42(7):983–92.
Lutsky K. Preoperative magnetic resonance imaging for evaluating scaphoid nonunion. J Hand Surg [Am]. 2012;37(11):2383–5.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Larribe, M., Gay, A., Freire, V. et al. Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture. Skeletal Radiol 43, 1697–1703 (2014). https://doi.org/10.1007/s00256-014-1981-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-014-1981-8