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Usefulness of Gadolinium-Enhanced MR Imaging in the Evaluation of the Vascularity of Scaphoid Nonunions

Luis Cerezal1, Faustino Abascal1, Ana Canga2, Roberto García-Valtuille1, Manuel Bustamante3 and Francisco del Piñal4

1 Department of Radiology, Hospital Mompía, Mompía (Cantabria) 39100, Spain.
2 Department of Radiology, Hospital Santa Cruz, Liencres (Cantabria) 39120, Spain.
3 Department of Radiology, University Hospital Marqués de Valdecilla, Santander 39008, Spain.
4 Unit of Hand Surgery, Hospital Mutua Montañesa, Santander 39012, Spain.



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  		Fig. 1. —22-year-old man with delayed union. Fracture occurred 11 months earlier.

A, Anteroposterior conventional radiograph shows displaced fracture through waist of scaphoid with sclerosis of proximal fragment.

 


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  		Fig. 1. —22-year-old man with delayed union. Fracture occurred 11 months earlier.

B, Sagittal T1-weighted spin-echo MR image reveals slight low signal intensity of proximal fragment (arrow).

 


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  		Fig. 1. —22-year-old man with delayed union. Fracture occurred 11 months earlier.

C, Sagittal fat-suppressed T1-weighted MR image obtained with gadolinium shows diffuse enhancement of proximal fragment (arrow). Patient healed after surgery.

 


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  		Fig. 2. —27-year-old man with long-standing pseudoarthrosis, dorsal segmental intercalated instability, synovitis, and advanced degenerative changes in radioscaphoid joint.

A, Coronal T1-weighted sequence shows proximal fragment is isointense to other carpal bones.

 


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  		Fig. 2. —27-year-old man with long-standing pseudoarthrosis, dorsal segmental intercalated instability, synovitis, and advanced degenerative changes in radioscaphoid joint.

B, Fat-suppressed T2-weighted MR image in coronal plane shows marked low signal intensity of proximal fragment (arrow).

 


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  		Fig. 2. —27-year-old man with long-standing pseudoarthrosis, dorsal segmental intercalated instability, synovitis, and advanced degenerative changes in radioscaphoid joint.

C, Coronal fat-suppressed T1-weighted MR image with gadolinium shows complete absence of enhancement in proximal fragment (arrow). Necrosis of proximal fragment was found at surgery. Resection of necrotic bone and wrist arthrodesis was performed. Histopathologic analysis of bone specimen confirmed necrosis.

 


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  		Fig. 3. —31-year-old man with nonunion of scaphoid waist fracture.

A, Coronal T1-weighted MR image shows moderate low signal intensity of proximal fragment (arrow).

 


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  		Fig. 3. —31-year-old man with nonunion of scaphoid waist fracture.

B, Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows absence of enhancement (arrow).

 


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  		Fig. 3. —31-year-old man with nonunion of scaphoid waist fracture.

C, Sagittal fat-suppressed T1-weighted MR image obtained with gadolinium shows patchy enhancement with viable bone (arrow) in palmar aspect of bone and necrosis in dorsal surface. Healing was achieved after surgical treatment with bone grafting and insertion of Herbert screw.

 


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  		Fig. 4. —41-year-old man with long-standing pseudoarthrosis.

A, Coronal T1-weighted MR image shows marked low signal intensity of proximal fragment.

 


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  		Fig. 4. —41-year-old man with long-standing pseudoarthrosis.

B, Coronal fat-suppressed T2-weighted MR image shows heterogeneous signal intensity of proximal fragment.

 


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  		Fig. 4. —41-year-old man with long-standing pseudoarthrosis.

C, Coronal gadolinium-enhanced fat-suppressed T1-weighted MR sequence reveals lack of enhancement (arrow). No points of punctate bleeding were found at surgery and proximal carpectomy was performed.

 


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  		Fig. 5. —22-year old man with displaced fracture in waist of scaphoid. Avascular necrosis was suspected because of painful synovitis and sclerosis of proximal fragment.

A, Coronal T1-weighted MR image shows marked low signal intensity of proximal fragment and radioscaphoid synovitis.

 


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  		Fig. 5. —22-year old man with displaced fracture in waist of scaphoid. Avascular necrosis was suspected because of painful synovitis and sclerosis of proximal fragment.

B, Fat-suppressed T2-weighted MR image in coronal plane shows high signal intensity in proximal fragment.

 


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  		Fig. 5. —22-year old man with displaced fracture in waist of scaphoid. Avascular necrosis was suspected because of painful synovitis and sclerosis of proximal fragment.

C, Coronal fat-suppressed T1-weighted MR image obtained with gadolinium reveals enhancement of proximal fragment. Patient healed after surgical treatment.

 

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