European Radiology

, Volume 24, Issue 2, pp 449–459 | Cite as

Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome

  • Oliver Schoierer
  • Konstantin Bloess
  • Daniel Bender
  • Iris Burkholder
  • Hans-Ulrich Kauczor
  • Gerhard Schmidmaier
  • Marc-André WeberEmail author



To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS).


Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans, K ep, iAUC and V e were correlated with union at CT 1 year later (n = 49).


Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9 %/50.0 % compared to 96.8 %/33.3 % using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans, K ep and Ve within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19).


DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome.

Key points

Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within bony non-unions.

Vascularised ununited fractures appear better at 1-year CT than poorly vascularised fractures.

Non-union healing after osteosynthesis or osteoinductive drugs fundamentally requires vascularity.

DCE MRI predicts treatment outcome better than the clinical Non-Union Scoring System.

DCE MRI is clinically feasible to predict treatment outcome in bony non-unions.


Dynamic contrast-enhanced magnetic resonance imaging Non-union Vascularity Fracture healing Non-Union Scoring System 



Contrast-enhanced ultrasound


Confidence interval


Computed tomography


Dynamic contrast-enhanced magnetic resonance imaging


Field of view


Initial area under the enhancement curve


Constant reflux between extravascular extracellular space and blood plasma


Volume transfer constant between blood plasma and extravascular extracellular space


Non-Union Scoring System


Receiver operating characteristic


Region of interest


Short tau inversion recovery


Echo time


Repetition time




Extravascular extracellular volume fraction


Volume interpolated breath-hold examination


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Oliver Schoierer
    • 1
  • Konstantin Bloess
    • 2
  • Daniel Bender
    • 1
  • Iris Burkholder
    • 3
  • Hans-Ulrich Kauczor
    • 2
  • Gerhard Schmidmaier
    • 1
  • Marc-André Weber
    • 2
    Email author
  1. 1.Heidelberg Trauma Research Group, Department of Orthopaedic and Trauma SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Nursing and HealthUniversity of Applied Sciences of the SaarlandSaarbrückenGermany

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