Radiography versus computed tomography for osseous staging of Kienböck's disease

This retrospective study compared the diagnostic accuracy of conventional radiography (CR) and computed tomography (CT) in classifying Kienböck's disease (KD) according to Lichtman staging. Besides age, cartilage condition and vascularity, bone morphology is important in choosing the most appropriate treatment in KD. In 278 patients, two musculoskeletal radiologists performed a consensus reading of 281 lunate necroses according to the Lichtman classification, based on CR and CT. Stage IIIc was most common in CR (43%) and CT (61%), followed by stage IIIa for CR (25%) and stage IV for CT (15%). In 67%, KD was classified as the same in both modalities. The KD stage had to be upgraded in CT in 34% of cases, notably with stage IIIa progressing to IIIc in 24 out of 69 patients and stage IIIb to IIIc in 23 out of 38 cases. Overall, the Lichtman score was significantly higher on CT. The findings suggest that CT is better than CR in accurately determining the stage of KD stage, indicating a potential shift towards more surgical salvage procedures.Level of evidence: III.