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Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union?

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Abstract

Objective

To assess dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) as a measure of vascularity in scaphoid delayed-union or non-union.

Materials and methods

Thirty-five patients (34 male, one female; mean age, 27.4 ± 9.4 years; range, 16–51 years) with scaphoid delayed-union and non-union who underwent DCE MRI of the scaphoid between September 2002 and October 2012 were retrospectively reviewed. Proximal fragment vascularity was classified as good, fair, or poor on unenhanced MRI, contrast-enhanced MRI, and DCE MRI. For DCE MRI, enhancement slope, Eslope comparison of proximal and distal fragments was used to classify the proximal fragment as good, fair, or poor vascularity. Proximal fragment vascularity was similarly graded at surgery in all patients. Paired t test and McNemar test were used for data comparison. Kappa value was used to assess level of agreement between MRI findings and surgical findings.

Results

Twenty-five (71 %) of 35 patients had good vascularity, four (11 %) had fair vascularity, and six (17 %) had poor vascularity of the proximal scaphoid fragment at surgery. DCE MRI parameters had the highest correlation with surgical findings (kappa = 0.57). Proximal scaphoid fragments with surgical poor vascularity had a significantly lower Emax and Eslope than those with good vascularity (p = 0.0043 and 0.027). The sensitivity, specificity, positive and negative predictive value and accuracy of DCE MRI in predicting impaired vascularity was 67, 86, 67, 86, and 80 %, respectively, which was better than that seen with unenhanced and post-contrast MRI. Flattened time intensity curves in both proximal and distal fragments were a feature of protracted non-union with a mean time interval of 101.6 ± 95.5 months between injury and MRI.

Conclusions

DCE MRI has a higher diagnostic accuracy than either non-enhanced MRI or contrast enhanced MRI for assessing proximal fragment vascularity in scaphoid delayed-union and non-union. For proper interpretation of contrast-enhanced studies in scaphoid vascularity, one needs to incorporate the time frame between injury and MRI.

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Acknowledgments

The work described in this paper was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No.SEG_CUHK02). Special thanks to Jason Leung, CUHK statistician, for his help with this manuscript.

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Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong, SAR, People’s Republic of China

    Alex W. H. Ng, James F. Griffith & Alvin Li

  2. Department of Medical Imaging, The University of Arizona Health Network, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ, 85724, USA

    Mihra S. Taljanovic

  3. Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China

    W. L. Tse & P. C. Ho

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  1. Alex W. H. Ng
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  4. Alvin Li
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Correspondence to Alex W. H. Ng.

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Ng, A.W.H., Griffith, J.F., Taljanovic, M.S. et al. Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union?. Skeletal Radiol 42, 983–992 (2013). https://doi.org/10.1007/s00256-013-1627-2

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  • DOI: https://doi.org/10.1007/s00256-013-1627-2

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