Schmitt Rainer, Kalb K H, Christopoulos G, Grunz J P
Department of Radiology, Rhön-Klinikum AG, Bad Neustadt, Germany.
Department of Radiology, University Hospital Würzburg, Würzburg, Germany.
Semin Musculoskelet Radiol. 2019 Oct;23(5):523-533. doi: 10.1055/s-0039-1695719. Epub 2019 Sep 25.
Regarding the upper extremity, osteonecrosis can relate to the humeral head and to any carpal bone, most commonly the lunate (Kienböck's disease), scaphoid (Preiser's disease and nonunion), and capitate bone (osteonecrosis of the capitate head). In children and adolescents, osteochondrosis is an important differential diagnosis at the epiphyses. Appropriate imaging of osteonecrosis depends on knowledge about blood supply, biomechanical load, and bone repair mechanisms. Contrast-enhanced MRI (ceMRI) enables the differentiation of up to three mostly band-shaped zones: necrotic tissue (proximal), hypervascular repair tissue (intermediate), and viable bone (distal). To distinguish between necrotic and repair zones, intravenous gadolinium is recommended in MRI. Osteosclerosis and insufficiency fractures in early and intermediate stages as well as osteoarthritis in advanced stages are best depicted using high-resolution CT (HRCT). The combination of HRCT and ceMRI allows for exact classification of osteonecrosis regarding morphology and viability.
关于上肢，骨坏死可累及肱骨头和任何腕骨，最常见的是月骨（Kienböck病）、舟骨（Preiser病和骨不连）和头状骨（头状骨头骨坏死）。在儿童和青少年中，骨软骨病是骨骺处重要的鉴别诊断。骨坏死的适当影像学检查取决于对血供、生物力学负荷和骨修复机制的了解。对比增强磁共振成像（ceMRI）能够区分多达三个主要呈带状的区域：坏死组织（近端）、高血管化修复组织（中间）和存活骨（远端）。为了区分坏死区和修复区，建议在磁共振成像中静脉注射钆。早期和中期的骨质硬化和不全骨折以及晚期的骨关节炎使用高分辨率CT（HRCT）显示最佳。HRCT和ceMRI的联合使用能够对骨坏死的形态和存活情况进行精确分类。
