Histologic and magnetic resonance imaging correlations in Kienböck's disease

Abstract

Nine patients had magnetic resonance imaging studies to aid in the diagnosis of wrist pain in the midcarpal region. Six had positive magnetic resonance imaging studies with a decrease in signal intensity from the area of the lunate, one had an occult ganglion, and two had negative studies. Among the six patients with a diagnosis of Kienböck's disease by magnetic resonance imaging, four patients had collapse of the lunate on plain radiographs, and the other two patients had normal wrist radiographs. Magnetic resonance imaging studies showed a substantial decrease in the signal intensity on T 1- and T 2-weighted images of the entire lunate in three patients, and three patients had focal areas of decreased signal intensity. All of the patients had a biopsy of the lunate at the time of surgery. The histology of the biopsies of the lunate appeared to correspond to the magnetic resonance imaging studies. Undecalcified bone specimens from the patients with Kienböck's disease showed marked osteonecrosis in three patients, focal areas of osteonecrosis in two patients, and alternating areas of osteonecrosis with dramatic areas of new bone formation in one patient. Although in four patients the diagnosis was obvious by plain radiographs, magnetic resonance imaging studies were essential in confirming the diagnosis in two patients and were helpful in ruling out the diagnosis in three patients.