Advanced imaging of kienböck’s disease

Abstract

In the past, Kienböck’s disease (lunatomalacia, osteonecrosis, or aseptic necrosis of the lunate) was diagnosed exclusively by plain radiography. New capabilities of computed tomography (CT) and magnetic resonance imaging (MRI) have improved image quality due to both spatial resolution and contrast resolution with the use of gadolinium in MRI. At the same time, knowledge in pathology (altered biomechanical load of the wrist, disturbed bone metabolism, and reparative mechanisms of the osteonecrotic bone) has increased. Consequently, early diagnosis and classification of Kienböck’s disease are now significantly influenced by the use of CT and MR imaging. High-resolution CT is used for evaluating the osseous microstructure of the lunate, whereas contrast-enhanced MRI is perfectly suited for assessing the viability of the bone marrow. When synoptically considering the pathoanatomic processes and high-resolution imaging, the Kienböck’s disease process can be visualized in all its stages, beginning with its precursors and initial reaction of the lunate, proceeding with osteosclerotic and collapsing changes and finally terminating in perilunate osteoarthritis. CT and MR imaging also allows the clinician to consider the differential diagnosis, the lunate viability and secondary changes following surgery. Advanced imaging methods should focus on early stages with respect to best treatment options. In this chapter, the imaging capabilities of CT and MRI in Kienböck’s disease are summarized and correlated with the underlying pathology.