{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:22:04Z","timestamp":1769091724276,"version":"3.49.0"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,4,1]],"date-time":"2016-04-01T00:00:00Z","timestamp":1459468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Bone regeneration depends on perfusion of the fracture tissue, whereby hypervascularity is associated with infection, which itself causes nonunions. To date, nonunion perfusion has not been assessed with contrast\u2010enhanced sonography. The aim of this study was to evaluate the potential of contrast\u2010enhanced sonography in the analysis of nonunion tissue perfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nonunion vascularity of 31 patients before revision surgery was prospectively examined with qualitative contrast\u2010enhanced sonography and dynamic contrast\u2010enhanced magnetic resonance imaging (MRI). Time\u2010intensity curves from 2\u2010minute contrast\u2010enhanced sonographic video clips were generated, and parameters such as wash\u2010in rate, rise time, and peak enhancement were quantified. On dynamic contrast\u2010enhanced MRI, the initial area under the enhancement curve was quantified. Preoperative radiographs, computed tomograms, the clinical nonunion score, laboratory infection features, as well as contrast\u2010enhanced sonographic and dynamic contrast\u2010enhanced MRI perfusion were correlated with microbiological results from the nonunion tissue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both qualitative and quantitative contrast\u2010enhanced sonography showed significant differences between infected and aseptic nonunions (<jats:italic>P<\/jats:italic> = .015 and .020). The qualitative dynamic contrast\u2010enhanced MRI analysis was not significant (<jats:italic>P<\/jats:italic>= .244), but after quantification, a strong correlation (<jats:italic>P<\/jats:italic> = .007) with microbiological results was noted. A receiver operating characteristic analysis calculated ideal cutoff values for quantitative contrast\u2010enhanced sonography and dynamic contrast\u2010enhanced MRI so that their combination detected infected nonunions with sensitivity and specificity of 88.9% and 77.3%, respectively. Clinical, radiologic, and laboratory examinations did not correlate with microbiological results (<jats:italic>P<\/jats:italic> &gt; .05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Contrast\u2010enhanced sonography can visualize the vascularity of nonunions in real time, while quantification software allows for a semiobjective evaluation of bone perfusion. The correlations of both quantitative contrast\u2010enhanced sonography and dynamic contrast\u2010enhanced MRI with microbiological results show their high value for differentiation of infected from aseptic nonunions.<\/jats:p><\/jats:sec>","DOI":"10.7863\/ultra.15.06107","type":"journal-article","created":{"date-parts":[[2016,4,21]],"date-time":"2016-04-21T22:07:52Z","timestamp":1461276472000},"page":"933-942","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Dynamic Contrast\u2010Enhanced Sonography and Dynamic Contrast\u2010Enhanced Magnetic Resonance Imaging for Preoperative Diagnosis of Infected 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