The role of imaging in the assessment of vascularity at hand and wrist

The viability of the bone is compromised in two main situations at the wrist: Kienb?ck's disease and scaphoid nonunion with avascular necrosis. Plain radiography and CT allow an accurate anatomical approach of morphological changes associated with avascular necrosis of the lunate and the scaphoid fracture with complications. CT is readily available to detect nondisplaced fractures. However, early forms of necrosis can be misdiagnosed and evaluation of bone vitality is impossible. MRI is the best imaging modality to detect avascular necrosis and the intravenous injection of gadolinium improves the specificity of diagnosis of necrosis. The lack of enhancement of the proximal fragment of the scaphoid leads the surgeon to use a vascular graft in the treatment of nonunion. The technique has its limitations. The bone necrosis is histologically complex and contrast enhancement does not mean necessarily viability. However, MRI is still the most powerful imaging modality in the assessment of the bone marrow.