Purpose: In the treatment of stage IIIB Kienböck disease, the ailing lunate preservation or resection is at the discretion of the surgeon’s preference with no clearly defined indications. The aim of this study was to identify whether gadolinium-enhanced magnetic resonance (MR) imaging is useful in the assessment of lunate vascularity in stage IIIB Kienböck disease, thereby providing an indication for lunate preservation or excision procedures. Methods: From February 2014 to September 2015, 7 patients of 46 years on average were diagnosed as stage IIIB Kienböck disease. According to Goldfarb’s modification of Lichtman’s classification, stage IIIB was established based on radioscaphoid (RS) angle of 60°. All patients underwent preoperative MR imaging with gadolinium enhancement and lunate excision arthroplasty during the vascularized capitate transposition. Histopathological examination of the excised lunate was performed to observe whether there existed vascular structures in the ailing bone. The enhanced area on the postcontrast MR imaging was compared with nonnecrotic area within the lunate specimen with regard to the shape and size. Results: In 6 patients, the precontrast T1-weighted imaging without fat saturation demonstrated hypointense signal within the lunate, whereas the postcontrast T1-weighted imaging with fat saturation demonstrated heterogeneous hyperintense signal within the lunate. The corresponding histopathological examination confirmed existence of vascular structures within the lunate. In 1 patient, both the precontrast and postcontrast T1-weighted imaging without fat saturation showed hypointense signal within the lunate, and the corresponding histopathologic examination confirmed complete osteonecrosis without vascular structures. The correlation of the area percentages between enhanced zone and nonnecrotic zone was significant (r = .897). Conclusions: The present study revealed that the presence or absence of vascularity within stage IIIB lunate could be distinguished preoperatively by enhanced MR imaging.
