Stage I
• Bone marrow edema due to ischemic damage without morphological changes
• Normal density of the lunate in radiography and attenuation at CT scan
• Low signal intensity on T1-weighted images and usually hyperintense on T2-weighted fat-suppressed images.
Stage II
• Sclerosis of the lunate bone due to chronic ischemic damage
• Increased density in radiography with preserved morphology
• CT is more accurate in determining subtle fracture lines and pseudo-cystic inclusions
• Low signal intensity on T1-weighted and variable signal intensity on T2-weighted images.
Stage III
• Sclerosis and collapse of the lunate
• No signs of degenerative arthritis changes in the other wrist bones
• Increased density in radiography and collapse of the lunate
• CT reveals fractures, deformity, and widening on the sagittal plane
• Low signal intensity on T1-weighted images and variable signal intensity on T2-weighted images.
Three subgroups
• Stage IIIa - no carpal instability (radio-scaphoid angle <60°)
• Stage IIIb - carpal instability (radio-scaphoid angle >60°)
• Stage IIIc - chronic coronal fractures of the lunate
Stage IV
• Collapse of the lunate
• Carpal instability • Radiocarpal and midcarpal degenerative arthritis
• Functional impairment
• High density in radiography and high CT attenuation
• Low signal intensity on T1 and T2-weighted images due to sclerosis and necrosis.
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