Eva LLopis MD, Presenter: Nothing to Disclose

Luis Aguilella MD, Abstract Co-Author: Nothing to Disclose

Pilar Ferrer MD, Abstract Co-Author: Nothing to Disclose

Victoria Higueras MD, Abstract Co-Author: Nothing to Disclose

Avascular necrosis(AVN) of the proximal pole in scaphoid non-union is a poor prognosis factor. Therefore, some surgeons recommend vascular bone grafts (VBG), although the usefulness of this surgical technique is difficult due to variability of functional and radiology measures. The purpose of this study is to analyze the ability of VBG to achieve bone healing and revascularization in well demonstrated AVN proximal pole and correlate multidetector CT (MDCT) and GD-MRI findings with clinical outcome and plain films.

From 28 patients treated with VBG,pedicled with bone graft using the 1st septal artery from the dorsal radius we have selected 12 patients that meet two criteria: unenhanced GD-MRI and lack of intraoperative punctate bleeding. MRI images have been obtained on a 1Tunit. All patients had pre and post-surgical gadolinium-enhanced MRI. In addition 7 patients had an early MRI (<3m post-surgery).4-slice CT was performed with 0.5mm thickness and reconstructed at 0.5mm intervals with postprocessing multiplanar and 3D reconstructions.

Mean age 28 years, nonunion present for 8 years on average. MDCT has confirmed bone healing in 8 patients and partial or no bone bridging in 4.GD-MRI has rendered good contrast uptake in 6 patients and normal enhancement compared with the other carpal bones in 2 patients, those with longer follow up and shape restoration. Patchy enhancement was shown in 2 and absent in 2 patients. In those patients with serial MRI follow-up a progressive decrease of the bone and synovial enhancement has been associated with bone healing and good clinical outcome (5/7).

We have observed good correlation between MDCT and GD-enhanced MRI. Those patients with bone healing showed signs of revascularization. The revascularization process can be assessed from the firsts months post-surgery where the uptake is markedly increased within the proximal pole. Such enhancement decreases and changes progressively to normal bone marrow signal.MDCT with MPR reconstructions permit an isotropic image and define exquisitely bone bridging. In addition MRI gives information about concomitants findings such as synovitis, providing a good imaging tool for the surgeon.

LLopis, E, Aguilella, L, Ferrer, P, Higueras, V, Assessing Revascularization of a Necrotic Proximal Pole in Scaphoid Nonunion: Multidetector CT (MDCT) and Gadolinium-enhanced MRI Correlation.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405761.html