title: Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture.
abstract: OBJECTIVE
  To evaluate the usefulness of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) for assessing the viability of the proximal pole of the scaphoid in patients with acute scaphoid fractures.
  
  
  METHODS
  Eighteen consecutive patients with acute scaphoid fracture who underwent dynamic gadolinium-enhanced MRI 7 days or less before surgery were prospectively included between August 2011 and December 2012. All patients underwent MR imaging with unenhanced images, enhanced images, and dynamic enhanced images. A radiologist first classified the MRI results as necrotic or viable based on T1- and T2-weighted images only, followed by a second blinded interpretation, this time including analysis of pre- and post-gadolinium administration images and a third blinded interpretation based on the time-intensity curve of the dynamic enhanced study. The standard of reference was the histologic assessment of a cylindrical specimen of the proximal pole obtained during surgery in all patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for unenhanced, enhanced, and dynamic gadolinium-enhanced MRI studies.
  
  
  RESULTS
  The sensitivity, specificity, PPV, and NPV were 67, 67, 50, and 80 % for unenhanced images, 83, 100, 100, and 92 for enhanced images, and 83, 92, 83, and 92 for dynamic contrast-enhanced images.
  
  
  CONCLUSIONS
  Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture.
authors.affiliation: Service d'imagerie médicale, Hôpital La Conception, 147 boulevard Baille, 13005, Marseille, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Larribe
authors.forename: André
authors.initials: A
authors.lastname: Gay
authors.forename: Veronique
authors.initials: V
authors.lastname: Freire
authors.forename: Corinne
authors.initials: C
authors.lastname: Bouvier
authors.forename: Christophe
authors.initials: C
authors.lastname: Chagnaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Souteyrand
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D021361:Scaphoid Bone / Q000293:injuries* / Q000473:pathology; D012680:Sensitivity and Specificity; D014954:Wrist Injuries / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium