CT arthrography has demonstrated a sensitivity, specificity, and accuracy between 94% and 100% for articular cartilage injury [22]. CT Wrist With IV Contrast CT wrist with IV contrast is not routinely performed in clinical practice, although there is an isolated report of dual- energy CT with IV contrast used to assess scaphoid osteonecrosis. In addition to the benefits afforded by the high spatial resolution of CT in the assessment of scaphoid fracture, the addition of contrast has been shown to be beneficial in the determination of proximal pole viability. A study of 19 wrists in 18 patients with dual-energy contrast-enhanced CT showed promising results in the assessment of proximal pole osteonecrosis in the setting of scaphoid fracture [55]. When compared with intraoperative assessment or histologic analysis, in a series of 18 patients who underwent dual-energy contrast-enhanced CT of the wrist there was a sensitivity of 100% and a specificity of 94% for the assessment of osteonecrosis of the proximal pole of the scaphoid following fracture [55]. CT Wrist Without and With IV Contrast There is no relevant literature to support the use of CT with IV contrast in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. CT Wrist Without IV Contrast The spatial resolution obtained with CT makes it well suited to assess for any trabecular bridging at the fracture site, nonunion, malunion, and the sclerosis and fragmentation of avascular necrosis. The isotropic acquisition and the ability to create 3-D models assists in surgical planning [27,28]. MR Arthrography Wrist There is no relevant literature to support the use of MR arthrography in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, or osteonecrosis.
Chronic Hand and Wrist Pain. CT arthrography has demonstrated a sensitivity, specificity, and accuracy between 94% and 100% for articular cartilage injury [22]. CT Wrist With IV Contrast CT wrist with IV contrast is not routinely performed in clinical practice, although there is an isolated report of dual- energy CT with IV contrast used to assess scaphoid osteonecrosis. In addition to the benefits afforded by the high spatial resolution of CT in the assessment of scaphoid fracture, the addition of contrast has been shown to be beneficial in the determination of proximal pole viability. A study of 19 wrists in 18 patients with dual-energy contrast-enhanced CT showed promising results in the assessment of proximal pole osteonecrosis in the setting of scaphoid fracture [55]. When compared with intraoperative assessment or histologic analysis, in a series of 18 patients who underwent dual-energy contrast-enhanced CT of the wrist there was a sensitivity of 100% and a specificity of 94% for the assessment of osteonecrosis of the proximal pole of the scaphoid following fracture [55]. CT Wrist Without and With IV Contrast There is no relevant literature to support the use of CT with IV contrast in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. CT Wrist Without IV Contrast The spatial resolution obtained with CT makes it well suited to assess for any trabecular bridging at the fracture site, nonunion, malunion, and the sclerosis and fragmentation of avascular necrosis. The isotropic acquisition and the ability to create 3-D models assists in surgical planning [27,28]. MR Arthrography Wrist There is no relevant literature to support the use of MR arthrography in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, or osteonecrosis.