Ogawa Takeshi, Nishiura Yasumasa, Hara Yuki, Okamoto Yoshikazu, Ochiai Naoyuki
Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda, Chiba, Japan.
J Hand Surg Am. 2012 Jan;37(1):83-9. doi: 10.1016/j.jhsa.2011.09.027. Epub 2011 Nov 3.
Diagnosis and treatment remain controversial for Kienböck disease. A few reports have correlated magnetic resonance imaging (MRI), which is essential for early diagnosis, and histopathology of Kienböck biopsy specimens, but histopathological correlations of whole lunate bones or histological slices compared with MRI images are lacking. The purpose of this study was to compare presurgical MRI scans with corresponding histological slices of Kienböck-diseased lunates.
We excised whole lunates at the time of surgery from 6 patients with Kienböck disease (stage IIIB) undergoing tendon-ball replacement or a Graner procedure. We stained paraffin-embedded, coronally sectioned specimens with hematoxylin-eosin and compared them with presurgical coronal scans using MRI with a 47-mm microscopy surface coil.
Toward the center of the lunates, the signal intensity in the proton density-weighted images was reduced, whereas the dorsal and palmar sides of the lunates exhibited no changes in intensity. In correlation, histopathological findings revealed strongly disrupted trabeculae toward the center of the lunates and intact trabeculae in the dorsal side of the lunates. Likewise, the necrotic and vitalized bone exhibited low and high signal intensities, respectively, in the proton density-weighted images; however, in the fast-field echo images, there were no correlations with histopathological observations.
Proton density-weighted MRIs but not fast-field echo images using a 47-mm microscopy coil reflected the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses of the lunate specimens.
Proton density-weighted MRIs accurately reflect the vascular status of the lunate and may help plan treatment on a case-by-case basis.
月骨无菌性坏死的诊断和治疗仍存在争议。一些报告将对早期诊断至关重要的磁共振成像（MRI）与月骨活检标本的组织病理学联系起来，但缺乏整个月骨或组织切片与MRI图像的组织病理学相关性研究。本研究的目的是比较月骨无菌性坏死患者术前MRI扫描结果与相应的月骨组织切片。
我们在手术时从6例接受肌腱球置换或格拉纳手术的月骨无菌性坏死（IIIB期）患者身上切除了整个月骨。我们用苏木精-伊红对石蜡包埋的冠状切片标本进行染色，并使用47毫米显微镜表面线圈的MRI将其与术前冠状扫描进行比较。
在月骨中心方向，质子密度加权图像中的信号强度降低，而月骨的背侧和掌侧强度没有变化。相应地，组织病理学结果显示，月骨中心方向的小梁严重破坏，而月骨背侧的小梁完整。同样，在质子密度加权图像中，坏死骨和存活骨分别表现为低信号强度和高信号强度；然而，在快速场回波图像中，与组织病理学观察结果没有相关性。
使用47毫米显微镜线圈的质子密度加权MRI而非快速场回波图像反映了月骨无菌性坏死月骨坏死区域的范围和定位，月骨标本的组织学分析证明了这一点。
质子密度加权MRI准确反映了月骨的血管状态，并可能有助于逐案制定治疗计划。
