Magnetic resonance imaging of avascular necrosis of the lunate

Avascular necrosis (AVN) of carpal bones, particularly the lunate, is often an elusive cause of wrist pain. Physical examination can be indistinguishable from that of a simple wrist sprain, and standard radiographic evaluations are frequently normal. Early diagnosis is critical, since late treatment is often simple observation of the natural history of the disease, which includes progressive collapse of the lunate and derangement of the carpal architecture. Magnetic resonance imaging (MRI) produces images of high contrast, demarcating necrotic from normal bone. We present a case of lunate AVN ("Kienböck's disease") to illustrate the ability of MRI to identify necrotic bone in the wrist. We suggest that MRI is useful in diagnosing AVN in the wrist and that it may allow an earlier diagnosis of lunate AVN than is possible with standard radiographs.