Findings
Coronal T1 (a), STIR (b)and sagittal STIR (c) MR images of wrist reveals diffuse bone marrow edema, patchy sclerosis of lunate bone associated with negative ulnar variance.
Diagnosis
Kienböck disease
Summary
Kienböck disease is a condition marked by avascular necrosis of the lunate bone. MRI is a highly effective means for evaluating the wrist in patients with Kienbock’s disease. MRI can help in visualizing the bone anatomy, the staging of Kienböck disease, and ruling out alternative diagnoses that mimic Kienböck disease. MR is much more sensitive than plain films and is more specific than bone scintigraphy. The earliest MRI manifestation of Kienböck disease is a linear intramedullary fracture traversing the mid lunate without marrow signal abnormality. This is followed by bone marrow signal abnormality in advanced stages. There is a significant association between negative ulnar variance and Kienböck disease. Treatments include mechanical lunate unloading to encourage spontaneous revascularization; direct lunate bone graft procedures; and more aggressive options, such as proximal row carpectomy, joint replacement, and carpal bone fusion
Diferential diagnosis
- Acute fracture or bone contusion – usually presents with acute episode of trauma to the hand
- Ulnar impaction syndrome – Bone marrow signal change is at the proximal ulnar aspect of lunate and more commonly associated with positive ulnar variance
Further reads
Arnaiz, J., Piedra, T., Cerezal, L., Ward, J., Thompson, A., Vidal, J. A., & Canga, A. (2014). Imaging of Kienböck disease. AJR. American journal of roentgenology, 203(1), 131–139. https://doi.org/10.2214/AJR.13.11606
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