Staging of Preiser's Disease Using Contrast-Enhanced Magnetic Resonance Imaging

Presentation Format: Scientific poster presentation.

Purpose or Learning Objective: To distinguish stages of Preiser's disease by means of perfusion patterns and to assess the linear extent of osteonecrosis in plain and contrast-enhanced magnetic resonance imaging (ceMRI).

Methods or Background: A total of 43 patients (27 women, 16 men; mean age: 39.9 ± 13.4 years) with Preiser's disease underwent ceMRI of the wrist. Negative trauma history and absence of scaphoid fractures were mandatory for study inclusion. Two radiologists analyzed two data sets for each patient in a consensus reading. One set contained coronal proton-density (PD) fast spin-echo (FSE) fs, sagittal T2 FSE fs, and plain T1 FSE sequences, with the latter acquired in the sagittal-oblique plane parallel to the longitudinal axis of the scaphoid. The second data set included additional T1 FSE fs sequences in coronal and sagittal-oblique orientation after intravenous application of gadolinium-based contrast agents. Observers were asked to gauge the maximum diameter of necrosis for each data set and state their confidence in the measurement on a 3-point scale.

Results or Findings: Signal intensity distribution showed little correlation between T2-/PD- and T1-weighted sequences. In three patients (7.0%), proximal T1 signal loss before and after gadolinium application was observed with adjacent normal bone signal, resulting in a two-layer appearance characteristic for chronic (non-reparative) necrosis. One patient (2.3%) presented an entirely necrotic scaphoid without T1 signal increase with contrast media. In 39 patients (90.7%), ceMRI displayed vascularized repair tissue between necrosis and viable bone marrow, leading to a three-layer signal distribution that indicates active (reparative) necrosis. On plain MRI, observers surmised the mean extent of necrosis as 10.0 mm (standard deviation [SD]: 3.3 mm). In ceMRI, the identified extent was considerably smaller (p < 0.001) with 7.4 mm (SD: 2.9 mm). Mean difference in Bland-Altman analysis was 2.9 mm (standard error of the estimate: 1.9 mm). Confidence in measurements was higher in ceMRI (p < 0.001).

Conclusion: Contrast-enhanced MRI is the method of choice for staging in Preiser's disease. With plain T1, hypervascular repair tissue cannot be discerned from necrotic bone, resulting in an overestimation of disease.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 June 2021