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Osteologie 2016; 25(03): 156-166
DOI: 10.1055/s-0037-1619015
Muskuloskelettale Radiologie
Schattauer GmbH

Karpale Osteonekrosen

Noch ein Nebeneinander von Ischämie und Hyperperfusion oder schon Nekrose?Osteonecrosis of the carpal bonesStill ischemia and hyperperfusion side-by-side or already necrosis?
R. Schmitt
1   Diagnostische und Interventionelle Radiologie, Herz-und Gefäß-Klinik GmbH, Bad Neustadt
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Further Information

Publication History

eingereicht: 22 March 2016

angenommen: 30 March 2016

Publication Date:
21 December 2017 (online)

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Zusammenfassung

In den vergangenen Jahren haben die Kenntnisse zur Gefäßanatomie, zur Biomechanik und zu den Reparationsmechanismen maßgeblich die bildgebende Diagnostik von Osteonekrosen des Skaphoids (Skaphoidpseudarthrose, Morbus Preiser), des Lunatums (Morbus Kienböck) und des Kapitatums (Kapitatumkopfnekrose) beeinflusst. Die kontrastverstärkte MRT eignet sich zuverlässig zur Bestimmung der Vitalität des Knochenmarks. Bei den Osteonekrosen können mit der MRT drei Zonen abgegrenzt werden: Proximal die Nekrosezone, in der Mitte die Reparationszone und distal die Zone der verbliebenen Knochenmarksvitalität. Voraussetzung für die Abgrenzung der Osteonekroseund Reparationszonen ist die intravenöse Gabe von Gadolinium. Die hochaufgelöste CT dient in den Frühstadien der Darstellung von Osteosklerosen und Insuffizienzfrakturen sowie in den Spätstadien dem Nachweis von arthrotischen Umbauten. Mit den dedizierten Schnittbildverfahren können alle Stadien der karpalen Osteonekrosen zur Abbildung gebracht werden, nämlich von den Vorstufen und Reparationsmechanismen über die Zwischenstufen mit Osteosklerose und proximalen Frakturen bis zu den Endstadien der Arthrose und des karpalen Kollapses.

Summary

In the past, knowledge about vascular supply, biomechanical load, and repairing mechanisms has significantly influenced imaging in osteonecrosis of the scaphoid bone (non-union and Preiser’s disease), the lunate bone (Kienböck’s disease) and capitate bone (necrosis of the capitate head). Contrast-enhanced MRI is perfectly suited for assessing the viability of the bone marrow. Three different zones can be depicted with the use of MRI: The proximal necrotic zone, the middle reparative zone, and the distal viability zone. Intravenous gadolinium is mandatory in MRI for differentiating the osteonecrotic zone from the reparative zone. High-resolution CT is used for depicting increased bone density, insufficiency fractures in early stages and osteoarthritic lesions in advanced stages of osteonecrosis. Advanced imaging procedures allow for assessing all the stages of carpal osteonecroses, beginning with the precursors and repairing reactions, proceeding with osteosclerosis and proximal fractures and finally terminating in osteoarthritis and carpal collapse.

Schlüsselwörter

CT - Gadolinium - Handwurzel - Hyperperfusion - Ischämie - Kapitatum - Knochenmark - Lunatum - MRT - Osteonekrose - Reparation - Skaphoid

Keywords

CT - gadolinium - wrist - hyperperfusion - ischemic bone - capitate - bone marrow - lunate - MRI - osteonecrosis - reparation - scaphoid
 

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