Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prediction of non-union consolidation

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• 作者：Christian Fischer^a ; ^{Christian.Fischer@med.uni-heidelberg.de} ; ^{mail@medfischer.de} ; Mareike Nissen^a ; Gerhard Schmidmaier^a ; Thomas Bruckner^b ; Hans-Ulrich Kauczor^c ; Marc-André ; Weber^c
• 关键词：Magnetic resonance imaging ; Non-union ; Diamond concept ; Masquelet ; Body mass index ; Perfusion ; Imaging ; NUSS
• 刊名：Injury
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：48
• 期：2
• 页码：357-363
• 全文大小：1382 K
• 卷排序：48

文摘

Non-union perfusion can be visualized with dynamic contrast-enhanced (DCE) MRI. This study evaluated DCE-MRI to predict non-union consolidation after surgery and detect factors that affect bone healing.Materials and methodsBetween 2010 and 2015 non-union perfusion was prospectively quantified in 205 patients (mean age, 51.5 years, 129 men, 76 women) before intervention and at 6, 12, 26, 52 and more weeks follow-up. DCE-MRI results were related to the osseous consolidation, the ability to predict successful outcome was estimated by ROC analysis. The relevance of the body mass index (BMI) and the non-union severity score (NUSS) to the healing process was assessed.ResultsTibial (n = 99) and femoral (n = 76) non-unions were most common. Consolidation could be assessed in 169 patients, of these 103 (61%) showed eventual healing and demonstrated higher perfusion than in failed consolidation at 6 (p = 0.0226), 12 (p = 0.0252) and 26 (p = 0.0088) weeks follow-up. DCE-MRI at 26 weeks follow-up predicted non-union consolidation with a sensitivity of 75% and a specificity of 87% (false classification rate 19%). Higher BMI (p = 0.041) and NUSS (p < 0.0001) were associated with treatment failure.ConclusionsDCE-MRI perfusion analysis after non-union surgery predicts successful outcome and could facilitate the decision of early intervention. NUSS and BMI are important prognostic factors concerning consolidation.