Semin Musculoskelet Radiol 2019; 23(05): 523-533
DOI: 10.1055/s-0039-1695719
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteonecrosis of the Upper Extremity: MRI-Based Zonal Patterns and Differential Diagnosis

1  Department of Radiology, Rhön-Klinikum AG, Bad Neustadt, Germany
2  Department of Radiology, University Hospital Würzburg, Würzburg, Germany
,
K.H. Kalb
3  Department of Hand Surgery, Rhön-Klinikum AG, Bad Neustadt, Germany
,
G. Christopoulos
1  Department of Radiology, Rhön-Klinikum AG, Bad Neustadt, Germany
,
J.P. Grunz
1  Department of Radiology, Rhön-Klinikum AG, Bad Neustadt, Germany
2  Department of Radiology, University Hospital Würzburg, Würzburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)

Abstract

Regarding the upper extremity, osteonecrosis can relate to the humeral head and to any carpal bone, most commonly the lunate (Kienböck's disease), scaphoid (Preiser's disease and nonunion), and capitate bone (osteonecrosis of the capitate head). In children and adolescents, osteochondrosis is an important differential diagnosis at the epiphyses. Appropriate imaging of osteonecrosis depends on knowledge about blood supply, biomechanical load, and bone repair mechanisms. Contrast-enhanced MRI (ceMRI) enables the differentiation of up to three mostly band-shaped zones: necrotic tissue (proximal), hypervascular repair tissue (intermediate), and viable bone (distal). To distinguish between necrotic and repair zones, intravenous gadolinium is recommended in MRI. Osteosclerosis and insufficiency fractures in early and intermediate stages as well as osteoarthritis in advanced stages are best depicted using high-resolution CT (HRCT). The combination of HRCT and ceMRI allows for exact classification of osteonecrosis regarding morphology and viability.