Scaphoid fracture and avascular necrosis (MR perfusion)
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Khalid Alhusseiny had no recorded disclosures.View Khalid Alhusseiny's current disclosures
Right wrist pain with history of a fall few months ago.
Loading Stack -
0 images remaining
There is a complete non-union transverse fracture line seen at the junction of the proximal 1/3 and distal 2/3 of the scaphoid bone. The scaphoid bone shows increased signal on T2 denoting underlying edema. The distal segment of the scaphoid shows patchy areas of reduced signal on T1, while the proximal segment shows diffuse low signal. Following contrast administration; the distal segment shows continuous contrast uptake with variable enhancement as evident on the color-coded map, while the proximal segment shows no contrast uptake as evident by the homogeneous low signal following contrast administration, absence of color saturation and the flat dynamic curve.
Avascular necrosis (AVN) is a known complication of scaphoid non-union fracture. MRI can help diagnose scaphoid AVN before the development of scaphoid collapse. The use of post-contrast MRI may not be required as the presence of decreased signal on T1 unenhanced MRI correlates well with AVN.
- Fox M, Wang D, Chhabra A. Accuracy of Enhanced and Unenhanced MRI in Diagnosing Scaphoid Proximal Pole Avascular Necrosis and Predicting Surgical Outcome. Skeletal Radiol. 2015;44(11):1671-8. doi:10.1007/s00256-015-2221-6 - Pubmed
- Fox M, Gaskin C, Chhabra A, Anderson M. Assessment of Scaphoid Viability With MRI: A Reassessment of Findings on Unenhanced MR Images. AJR Am J Roentgenol. 2010;195(4):W281-6. doi:10.2214/ajr.09.4098 - Pubmed
- Donati O, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann C. 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. doi:10.1148/radiol.11110125 - Pubmed