Download PDF
Osteologie 2016; 25(03): 156-166
DOI: 10.1055/s-0037-1619015
Muskuloskelettale Radiologie
Schattauer GmbH

Karpale Osteonekrosen

Noch ein Nebeneinander von Ischämie und Hyperperfusion oder schon Nekrose?Osteonecrosis of the carpal bonesStill ischemia and hyperperfusion side-by-side or already necrosis?
R. Schmitt
1   Diagnostische und Interventionelle Radiologie, Herz-und Gefäß-Klinik GmbH, Bad Neustadt
› Author Affiliations
Further Information

Publication History

eingereicht: 22 March 2016

angenommen: 30 March 2016

Publication Date:
21 December 2017 (online)

    Permissions and Reprints

Zusammenfassung

In den vergangenen Jahren haben die Kenntnisse zur Gefäßanatomie, zur Biomechanik und zu den Reparationsmechanismen maßgeblich die bildgebende Diagnostik von Osteonekrosen des Skaphoids (Skaphoidpseudarthrose, Morbus Preiser), des Lunatums (Morbus Kienböck) und des Kapitatums (Kapitatumkopfnekrose) beeinflusst. Die kontrastverstärkte MRT eignet sich zuverlässig zur Bestimmung der Vitalität des Knochenmarks. Bei den Osteonekrosen können mit der MRT drei Zonen abgegrenzt werden: Proximal die Nekrosezone, in der Mitte die Reparationszone und distal die Zone der verbliebenen Knochenmarksvitalität. Voraussetzung für die Abgrenzung der Osteonekroseund Reparationszonen ist die intravenöse Gabe von Gadolinium. Die hochaufgelöste CT dient in den Frühstadien der Darstellung von Osteosklerosen und Insuffizienzfrakturen sowie in den Spätstadien dem Nachweis von arthrotischen Umbauten. Mit den dedizierten Schnittbildverfahren können alle Stadien der karpalen Osteonekrosen zur Abbildung gebracht werden, nämlich von den Vorstufen und Reparationsmechanismen über die Zwischenstufen mit Osteosklerose und proximalen Frakturen bis zu den Endstadien der Arthrose und des karpalen Kollapses.

Summary

In the past, knowledge about vascular supply, biomechanical load, and repairing mechanisms has significantly influenced imaging in osteonecrosis of the scaphoid bone (non-union and Preiser’s disease), the lunate bone (Kienböck’s disease) and capitate bone (necrosis of the capitate head). Contrast-enhanced MRI is perfectly suited for assessing the viability of the bone marrow. Three different zones can be depicted with the use of MRI: The proximal necrotic zone, the middle reparative zone, and the distal viability zone. Intravenous gadolinium is mandatory in MRI for differentiating the osteonecrotic zone from the reparative zone. High-resolution CT is used for depicting increased bone density, insufficiency fractures in early stages and osteoarthritic lesions in advanced stages of osteonecrosis. Advanced imaging procedures allow for assessing all the stages of carpal osteonecroses, beginning with the precursors and repairing reactions, proceeding with osteosclerosis and proximal fractures and finally terminating in osteoarthritis and carpal collapse.

Schlüsselwörter

CT - Gadolinium - Handwurzel - Hyperperfusion - Ischämie - Kapitatum - Knochenmark - Lunatum - MRT - Osteonekrose - Reparation - Skaphoid

Keywords

CT - gadolinium - wrist - hyperperfusion - ischemic bone - capitate - bone marrow - lunate - MRI - osteonecrosis - reparation - scaphoid
 

  • Literatur

  • 1 Gelberman RH, Bauman TH, Menon J, Akeson W. The vascularity of the lunate bone and Kienböck`s disease. J Hand Surg 1980; 05: 272-278.
    CrossrefPubMedGoogle Scholar
  • 2 Lluch A, Garcia-Elias M. Etiology of Kienböck Disease. Tech Hand Surg 2011; 15: 33-37.
    Google Scholar
  • 3 Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg 1980; 05: 508-513.
    CrossrefPubMedGoogle Scholar
  • 4 Ståhl F. On lunatomalacia (Kienboeck`s disease): A clinical und roentgenological study, especially on its pathogenesis and the late results of immobilization treatment. Acta Chir Scand 1947; 126: 1-133.
    Google Scholar
  • 5 White RE, Omer Jr GE. Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus. J Hand Surg Am 1984; 09: 181-184.
    Google Scholar
  • 6 Krimmer H, Schmitt R, Herbert T. Kahnbeinfrakturen – Diagnostik, Klassifikation und Therapie. Unfallchir 2000; 102: 812-819.
    Google Scholar
  • 7 Schiltenwolf M, Martini AK, Mau HC. et al. Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck’s disease). J Hand Surg 1996; 21A: 754-758.
    PubMedGoogle Scholar
  • 8 Hultén O. Über die Entstehung und Behandlung der Lunatumnekrose. Acta Chir Scand 1935; 76: 121-135.
    Google Scholar
  • 9 Gelberman RH, Salomon RB, Jurist JM. et al. Ulnar variance in Kienbock’s disease. J Bone Joint Surg [Am] 1975; 57: 674-676.
    CrossrefPubMedGoogle Scholar
  • 10 Desser TS, McCarthy S, Trumble T. Scaphoid fractures and Kienböck`s disease of the lunate: MR imaging with histopathologic correlation. Magn Reson Imag 1990; 08: 357-362.
    CrossrefPubMedGoogle Scholar
  • 11 Trumble TE, Irving J. Histologic and magnetic resonance imaging correlations in Kienböck`s disease. J Hand Surg [Am] 1990; 15: 879-884.
    CrossrefPubMedGoogle Scholar
  • 12 Aspenberg P, Wang JS, Jonsson K. et al. Experimental osteonecrosis of the lunate. Revascularization may cause collapse. J Hand Surg [Br] 1994; 19: 565-569.
    Google Scholar
  • 13 Hashizume H, Asahara H, Nishida K. et al. Histopathology of Kienboeck’s disease. Correlation with magnetic resonance and other imaging techniques. J Hand Surg Br 1996; 21: 89-93.
    PubMedGoogle Scholar
  • 14 Ogawa T, Nishiura Y, Hara Y. et al. Correlation of histopathology with magnetic resonance imaging in Kienböck’s disease. J Hand Surg [Am] 2012; 37: 83-89.
    CrossrefPubMedGoogle Scholar
  • 15 Freyschmidt J. Skeletterkrankungen: Klinischradiologische Diagnose und Differentialdiagnose, 4. Auflage. Berlin, Heidelberg: Springer; 2015
    Google Scholar
  • 16 Hidaka Y, Nakamura R. Progressive patterns of degenerative arthritis in scaphoid nonunion demonstrated by three-dimensional computed tomography. J Hand Surg Br 1998; 23: 765-770.
    CrossrefPubMedGoogle Scholar
  • 17 Schmitt R, Fellner F, Obletter N. et al. Diagnostik und Stadieneinteilung der Lunatumnekrose. Eine aktuelle Übersicht. Handchir Mikrochir Plast Chir 1998; 30: 142-150.
    PubMedGoogle Scholar
  • 18 Coblenz G, Christopoulos G, Fröhner S. et al. Die Skaphoidfraktur und -pseudarthrose: Eine aktuelle Standortbestimmung zur radiologischen Diagnostik. Radiologe 2006; 46: 666-676.
    Google Scholar
  • 19 Schmitt R, Heinze A, Fellner F. et al. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol 1997; 25: 92-103.
    CrossrefPubMedGoogle Scholar
  • 20 Schmitt R, Kalb KH. Bildgebende Diagnostik der Lunatumnekrose. Handchir Mikrochir Plast Chir 2010; 42: 162-170.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Schmitt R, Christopoulos G, Wagner M. et al. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: Is intravenous contrast agent necessary in MRI?. Eur J Radiol 2011; 77: 222-227.
    CrossrefPubMedGoogle Scholar
  • 22 Decoulx P, Marchand M, Minet P, Razemon JP. La Maladie de Kienböck chez le mineur. Lille chir 1957; 12: 65-81.
    PubMedGoogle Scholar
  • 23 Herbert TJ. The fractured scaphoid. St. Louis: Matthew Medical Books; 1990
    Google Scholar
  • 24 Lauder AJ, Trumble TE. Idiopathic avascular necrosis of the scaphoid: Preiser’s disease. Hand Clin 2006; 22: 475-484.
    CrossrefPubMedGoogle Scholar
  • 25 Peters SJ, Degreef I, De Smet L. Avascular necrosis of the capitate: report of six cases and review of the literature. J Hand Surg Eur Vol 2015; 40: 520-525.
    CrossrefPubMedGoogle Scholar
  • 26 Youm Y, McMurtry RY, Flatt AE. et al. Kinematics of the wrist. Part I – an experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg (Am) 1978; 60: 423-431.
    Google Scholar
  • 27 Friedman L, Yong-Hing K, Johnston GH. The use of coronal computed tomography in the evaluation of Kienböck`s disease. Clin Radiol 1991; 44: 56-59.
    CrossrefPubMedGoogle Scholar
  • 28 Van de Berg BC, Malghem J, Lecouvet FE. et al. MRI of the normal bone marrow. Skeletal Radiol 1998; 27: 471-483.
    CrossrefPubMedGoogle Scholar
  • 29 Desser TS, McCarthy S, Trumble T. Scaphoid fractures and Kienböck`s disease of the lunate: MR imaging with histopathologic correlation. Magn Reson Imag 1990; 08: 357-361.
    CrossrefPubMedGoogle Scholar
  • 30 Sowa DT, Holder LE, Patt PG. et al. Application of magnetic resonance imaging to ischemic necrosis of the lunate. J Hand Surg [Am] 1989; 14: 1008-1016.
    CrossrefPubMedGoogle Scholar
  • 31 Trumble TE, Irving J. Histologic and magnetic resonance imaging correlations in Kienböck`s disease. J Hand Surg 1990; 15A: 879-884.
    Google Scholar
  • 32 Reinus WR, Conway WF, Totty WG. et al. Carpal avascular necrosis: MR imaging. Radiology 1986; 160: 689-693.
    CrossrefPubMedGoogle Scholar
  • 33 Kalainov DM, Cohen MS, Hendrix RW. et al. Preiser’s disease: identification of two patterns. J Hand Surg Am 2003; 28: 767-778.
    CrossrefPubMedGoogle Scholar
  • 34 Cerezal L, Abascal F, Canga A. et al. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. Am J Roentgenol 2000; 174: 141-149.
    CrossrefPubMedGoogle Scholar
  • 35 Donati OF, Zanetti M, Nagy L. et al. Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion?. Radiology 2011; 260: 808-816.
    CrossrefPubMedGoogle Scholar
  • 36 Kalb K, Pillukat T, Schmitt R. et al. Die Lunatumnekrose im Kindesund Jugendalter. Handchir Mikrochir Plast Chir 2010; 42: 187-197.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Lichtman DM, Ross G. Revascularization of the lunate in Kienböck’s disease. In Gelberman RH. ed. The Wrist. New York: Raven Press; 1994: 363-372.
    Google Scholar
  • 38 Goldfarb CA, Hsu J, Gelberman RH. et al. The Lichtman classification for Kienböck’s disease: an assessment of reliability. J Hand Surg [Am] 2003; 28: 74-80.
    PubMedGoogle Scholar
  • 39 Arnaiz J, Piedra T, Cerezal L. et al. Imaging of Kienböck disease. Am J Roentgenol 2014; 203: 131-139.
    CrossrefPubMedGoogle Scholar
  • 40 Schmitt R, Christopoulos G, Kalb K. et al. Zur Differenzialdiagnostik des “signalkompromittierten” Os lunatum in der MR-Tomographie. Fortschr Röntgenstr 2005; 177: 358-366.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Cerezal L, del Pinal F, Abascal F. et al. Imaging findings in ulnar-sided wrist impaction syndromes. Radio Graphics 2002; 22: 105-121.
    Google Scholar
  • 42 Imaeda T, Nakamura R, Shionoya K. et al. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201: 495-500.
    CrossrefPubMedGoogle Scholar
  • 43 Steinborn M, Schurmann StaeblerM. et al. MR imaging of ulnocarpal impaction after fracture of the distal radius. Am J Roentgenol 2003; 181: 195-198.
    CrossrefPubMedGoogle Scholar
  • 44 Trojan E, Jahna H. Die konservative Behandlung des veralteten Kahnbeinbruches der Hand. Arch Orthop Unfallchir 1955; 47: 99-104.
    CrossrefPubMedGoogle Scholar
  • 45 Vender MI, Watson HK, Wiener BD. et al. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg 1987; 12A: 514-519.
    Google Scholar
  • 46 Crema MD, Zentner J, Guermazi A. et al. Scapholunate advanced collapse and scaphoid nonunion advanced collapse: MDCT arthrography features. Am J Roentgenol 2012; 199: W202-W207.
    CrossrefPubMedGoogle Scholar
  • 47 Vogl TJ, Beutel F, Wilhelm K. et al. Skaphoidpseudarthrose mit Gd-DTPA – Stadieneinteilung und klinische Korrelation. Fortschr Röntgenstr 1994; 161: 438-445.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Schmitt R, Fröhner S, van Schoonhoven J. et al. Idiopathic osteonecrosis of the scaphoid (Preiser’s disease): MRI gives new insights into etiology and pathology. Eur J Radiol 2011; 77: 228-234.
    CrossrefPubMedGoogle Scholar
  • 49 Prommersberger KJ, van Schoonhoven J, Lanz U. Aseptische Nekrose des Kapitatums: Eine seltene Ursache für Handgelenkschmerzen. Fallbericht und Literaturübersicht. Handchir Mikrochir Plast Chir 2000; 32: 123-128.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Fenton RL. The naviculo-capitate fracture syndrome. J Bone Joint Surg 1956; 38A: 681-684.
    Google Scholar
  • 51 Caffey J, Silverman WA. Infantile Cortical Hyperostosis. Preliminary report on a new syndrome. Am J Roentgenol 1945; 54: 1-16.
    Google Scholar