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Imaging Techniques to Diagnose Scaphoid Proximal Pole Necrosis: A Comparison of Radiography, Computed Tomography, and Magnetic Resonance Imaging
Sophia Jacobi, BA
1, Emily Davidovic-Katz, BA
1, Samara Moll, BS
2, Janos Barrera, MD
1; Jacques H. Hacquebord, MD
1(1)NYU Langone Health, New York, NY, (2)NYU Langone Health, New York City, NY
Introduction: Irreversible osteonecrosis of proximal pole of scaphoid is commonly diagnosed through imaging, namely magnetic imaging resonance (MRI), computed tomography (CT), and radiography (X-ray). Osteonecrosis significantly influences prognosis and, consequently, informs the treatment plan. We hypothesize that all three imaging modalities are unreliable in identifying true osteonecrosis of the proximal pole of the scaphoid.
Methods: This is a retrospective review of all patients diagnosed with scaphoid proximal pole osteonecrosis secondary to scaphoid fracture from January 2018 to November 2024. Diagnostic imaging used included MRI, CT, and X-ray. Patients were grouped by diagnostic technique for comparison. Patient demographics and long term outcome of osteonecrosis healing were collected. Osteonecrosis is fundamentally defined as dead bone tissue with no chance of healing. Therefore, if a patient's osteonecrosis resolved it was a misdiagnosis and thus coded as not osteonecrosis. Regression analysis was used to compare the accuracy of imaging techniques to diagnose scaphoid proximal pole necrotic bone.
Results: A total of 74 patients met inclusion criteria for this study. 42/74 (56.8%) patients were diagnosed by CT with 24/42 (57.1%) patients having true osteonecrosis. 13/74 (17.6%) patients were diagnosed with MRI. 5/13 (38.5%) patients had true osteonecrosis. Lastly, 37/74 (50.0%) patients were diagnosed by X-ray, while 18/37 (48.7%) of those had true osteonecrosis. Univariate regression analysis did not demonstrate a statistically significant association between any imaging modality and the detection of osteonecrosis. Further, the imaging technique used to diagnose osteonecrosis was found to influence a surgeon's decision to intervene surgically. Necrosis found on CT significantly increased the odds of surgical intervention (p=0.006). In contrast, osteonecrosis diagnosed on X-ray significantly decreased the odds of surgical intervention (p=0.015).
Conclusion: Our results demonstrate there is no significant difference between imaging techniques - CT, MRI, and radiography, to accurately diagnose dead scaphoid proximal pole bone tissue. These data jointly suggest that more advanced imaging modalities (MRI and CT) are not superior in detecting scaphoid osteonecrosis compared to standard radiographs. Therefore, surgeons should exercise caution when using imaging findings of osteonecrosis to guide treatment decisions, as imaging cannot reliably detect true osteonecrosis.
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