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Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS).

Methods

Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans, K ep, iAUC and V e were correlated with union at CT 1 year later (n = 49).

Results

Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9 %/50.0 % compared to 96.8 %/33.3 % using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans, K ep and Ve within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19).

Conclusions

DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome.

Key points

• Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within bony non-unions.

• Vascularised ununited fractures appear better at 1-year CT than poorly vascularised fractures.

• Non-union healing after osteosynthesis or osteoinductive drugs fundamentally requires vascularity.

• DCE MRI predicts treatment outcome better than the clinical Non-Union Scoring System.

• DCE MRI is clinically feasible to predict treatment outcome in bony non-unions.

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

CI:

Confidence interval

CT:

Computed tomography

DCE MRI:

Dynamic contrast-enhanced magnetic resonance imaging

FOV:

Field of view

iAUC:

Initial area under the enhancement curve

K ep :

Constant reflux between extravascular extracellular space and blood plasma

K trans :

Volume transfer constant between blood plasma and extravascular extracellular space

NUSS:

Non-Union Scoring System

ROC:

Receiver operating characteristic

ROI:

Region of interest

STIR:

Short tau inversion recovery

TE:

Echo time

TR:

Repetition time

TSE:

Turbo-spin-echo

V e :

Extravascular extracellular volume fraction

VIBE:

Volume interpolated breath-hold examination

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Authors and Affiliations

  1. Heidelberg Trauma Research Group, Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstr. 200a , D-69118, Heidelberg, Germany

    Oliver Schoierer, Daniel Bender & Gerhard Schmidmaier

  2. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany

    Konstantin Bloess, Hans-Ulrich Kauczor & Marc-André Weber

  3. Department of Nursing and Health, University of Applied Sciences of the Saarland, Goebenstr. 40, D-66117, Saarbrücken, Germany

    Iris Burkholder

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  1. Oliver Schoierer
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  2. Konstantin Bloess
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  4. Iris Burkholder
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  5. Hans-Ulrich Kauczor
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  6. Gerhard Schmidmaier
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  7. Marc-André Weber
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Correspondence to Marc-André Weber.

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Schoierer, O., Bloess, K., Bender, D. et al. Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome. Eur Radiol 24, 449–459 (2014). https://doi.org/10.1007/s00330-013-3043-3

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  • DOI: https://doi.org/10.1007/s00330-013-3043-3

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