Imaging of Dupuytren's Disease: What's New?

Presentation Format: Scientific poster presentation.

Purpose or Learning Objective: (1) To correlate new insights of a more detailed surgical anatomy of palmar aponeurosis with high-resolution ultrasonography (US) and magnetic resonance imaging (MRI) in healthy persons and to describe anatomical structures that previously were not reported on imaging studies; and (2) to describe new imaging signs of Dupuytren's disease.

Methods or Background: Dupuytren's disease (palmar fibromatosis) is a chronic benign fibroproliferative disorder of the palmar and digital fasciae, characterized by the formation of nodules and fibrous cords, possibly causing flexion contractures of the finger joints. Recent anatomical studies introduced a more detailed anatomy of the palmar aponeurosis and related structures.

From the apex, over the flexor retinaculum, the pretendinous bands run distally, deep to the subcutaneous fat at a distance from the flexor tendons toward three terminal branches. Superficial branches attach cutaneously between the distal palmar and proximal digital crease. The bands of Gosset continue distally in a longitudinal course underneath the digital arteries toward the web space coalescence. The deep branches move dorsally along the flexor tendons in a sagittal course and insert on the deep transverse metacarpal ligament. Connecting these pretendinous bands, Skoogs ligament and the natatory ligament run transversely.

We performed high-resolution US and MRI in 10 healthy volunteers. Twenty patients with Dupuytren's disease underwent the same imaging procedures.

US was performed on a Canon Aplio i800, with a linear i24-LX8 transducer. MRI was performed on a GE 3-T Discovery MR750w, with a dedicated wrist coil. Transverse and sagittal 512 × 512 matrix T1-weighted images were acquired of the distal palm and proximal fingers.

Results or Findings: In our control group, we assessed visibility (partial/complete) of the various anatomical structures. In the patient group, we assessed which structures showed signs of pathology. In several structures, specific pathologic morphology was noted, for which we propose new morphological signs, such as the tardigrade and manifold signs.

Conclusion: Familiarity with the detailed imaging anatomy and new imaging signs of Dupuytren's disease will aid in confirming a correct and early diagnosis and distinguishing this disease from various other entities. US can be used in preoperative mapping and to establish which structures are most involved.

Publication History

Article published online:
03 June 2021