51
|
Mugnai R, Della Rosa N, Tarallo L. Scapholunate interosseous ligament injury in professional volleyball players. HAND SURGERY & REHABILITATION 2016; 35:341-347. [DOI: 10.1016/j.hansur.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/30/2016] [Accepted: 07/21/2016] [Indexed: 12/21/2022]
|
52
|
Hafezi-Nejad N, Carrino JA, Eng J, Blackmore C, Shores J, Lifchez SD, Farahani SJ, Demehri S. Scapholunate Interosseous Ligament Tears: Diagnostic Performance of 1.5 T, 3 T MRI, and MR Arthrography-A Systematic Review and Meta-analysis. Acad Radiol 2016; 23:1091-103. [PMID: 27426979 DOI: 10.1016/j.acra.2016.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury. MATERIALS AND METHODS A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included. RESULTS Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25-42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P < 0.001) but not for 3.0 T MRI (chi-square: 8.00, P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1-51.4), 75.7% (66.8-83.2), and 82.1% (76.1-87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3-83.4), 97.1% (89.8-99.6), and 92.8% (90.2-94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71-11.39), 23.23 (3.16-171.00), and 65.04 (32.89-128.62) (P value < 0.001), respectively. The results were consistent after addressing publication bias and sensitivity analyses. CONCLUSIONS MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.
Collapse
Affiliation(s)
- Nima Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287.
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
| | - Craig Blackmore
- The Center for Healthcare Improvement Science and Department of Radiology, Virginia Mason Medical Center, Seattle, Washington
| | - Jaimie Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Sahar Jalali Farahani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
| |
Collapse
|
53
|
Axial Traction During Direct Wrist MR Arthrography Helps Better Assess Articular Cartilage and Intrinsic Ligaments but Has Limited Value for Detection and Characterization of Triangular Fibrocartilage Complex Injuries. AJR Am J Roentgenol 2016; 207:W42. [PMID: 27548002 DOI: 10.2214/ajr.16.16491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
54
|
von Borstel D, Wang M, Small K, Nozaki T, Yoshioka H. High-Resolution 3T MR Imaging of the Triangular Fibrocartilage Complex. Magn Reson Med Sci 2016; 16:3-15. [PMID: 27535592 PMCID: PMC5600038 DOI: 10.2463/mrms.rev.2016-0011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study is intended as a review of 3Tesla (T) magnetic resonance (MR) imaging of the triangular fibrocartilage complex (TFCC). The recent advances in MR imaging, which includes high field strength magnets, multi-channel coils, and isotropic 3-dimensional (3D) sequences have enabled the visualization of precise TFCC anatomy with high spatial and contrast resolution. In addition to the routine wrist protocol, there are specific techniques used to optimize 3T imaging of the wrist; including driven equilibrium sequence (DRIVE), parallel imaging, and 3D imaging. The coil choice for 3T imaging of the wrist depends on a number of variables, and the proper coil design selection is critical for high-resolution wrist imaging with high signal and contrast-to-noise ratio. The TFCC is a complex structure and is composed of the articular disc (disc proper), the triangular ligament, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament (UCL), the extensor carpi ulnaris (ECU) tendon sheath, and the ulnolunate and ulnotriquetral ligaments. The Palmer classification categorizes TFCC lesions as traumatic (type 1) or degenerative (type 2). In this review article, we present clinical high-resolution MR images of normal TFCC anatomy and TFCC injuries with this classification system.
Collapse
|
55
|
Abstract
Purpose: To evaluate the degree of joint distraction during direct MR arthrography with axial traction in sports injuries. To confirm the effect of axial traction on the quality of wrist opacification. Patients and methods: Seventeen patients (11 male, 6 female) underwent wrist MR arthrography without (mean: 39 years (SD 11.6))., and 20 patients (16 male, 4 female) with axial traction (mean: 28 years (SD 7.1)). Subgroups were defined according to pathology: degenerative, ligamentous, traumatic, normal (ie patients without MR-arthrography lesions). Radioscaphoid, radiolunate, lunocapitate, ulna Triangular Fibrocartilage (TFC), scapho-lunate, luno-triquetral, ulnocarpal, Carpo-Metacarpal (CMC) I and III and distal radio-ulnar spaces were measured for all patients. Differences in joint space width were compared between subgroups. Joint space opacification was subjectively scored from 0 (no opacification) to 3 (fully opacified), and compared between the groups with and without traction. Results: The difference in joint space was statistically significant (p<0.05) for radioscaphoid, radiolunate, lunocapitate and ulnocarpal spaces, but only in patients with ligamentous tears. Opacification score was significantly higher for ulnocarpal (p=0.0275) and CMC III joint spaces (p=0.0272) with axial traction. Conclusion: Axial traction resulted in a significantly higher radioscaphoid, radio-lunate, lunocapitate and ulnocarpal joint spaces width. This positive effect of axial traction raises the suspicion of sports ligamentous lesions.
Collapse
|
56
|
Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients. Scand J Surg 2016; 106:173-179. [DOI: 10.1177/1457496916659226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. Materials and Methods: Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. Results: For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. Conclusion: Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in evaluating patients with wrist pain.
Collapse
|
57
|
Lee RKL, Griffith JF, Ng AWH, Law EKC, Tse WL, Wong CWY, Ho PC. Intrinsic carpal ligaments on MR and multidetector CT arthrography: comparison of axial and axial oblique planes. Eur Radiol 2016; 27:1277-1285. [DOI: 10.1007/s00330-016-4436-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 02/29/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
|
58
|
Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage. AJR Am J Roentgenol 2016; 206:155-61. [PMID: 26700348 DOI: 10.2214/ajr.15.14948] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments. SUBJECTS AND METHODS A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction. RESULTS With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears. CONCLUSION Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.
Collapse
|
59
|
LiMarzi GM, O'Dell MC, Scherer K, Pettis C, Wasyliw CW, Bancroft LW. Magnetic Resonance Arthrography of the Wrist and Elbow. Magn Reson Imaging Clin N Am 2016. [PMID: 26216774 DOI: 10.1016/j.mric.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Magnetic resonance (MR) arthrography of the wrist and elbow is useful for detecting a variety of intra-articular pathologies. MR dictations should address whether intrinsic ligament tears of the wrist are partial-thickness or full-thickness, and involve the dorsal, membranous, and/or volar components of the ligaments. With regard to elbow soft tissue pathology, partial-thickness tears of the anterior band of the ulnar collateral ligament in overhead-throwing athletes are well evaluated with MR arthrography. MR arthrography also is helpful in staging osteochondritis dissecans of the capitellum, caused by repetitive valgus impaction injury in adolescent or young adult baseball pitchers.
Collapse
Affiliation(s)
- Gary M LiMarzi
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - M Cody O'Dell
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Kurt Scherer
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Christopher Pettis
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Christopher W Wasyliw
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Laura W Bancroft
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA.
| |
Collapse
|
60
|
Ramamurthy NK, Chojnowski AJ, Toms AP. Imaging in carpal instability. J Hand Surg Eur Vol 2016; 41:22-34. [PMID: 26586689 DOI: 10.1177/1753193415610515] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
Carpal instability is a complex and heterogeneous clinical condition. Management requires accurate identification of structural injury with an understanding of the resultant movement (kinematic) and load transfer (kinetic) failure. Static imaging techniques, such as plain film radiography, stress views, ultrasound, magnetic resonance, MR arthrography and computerized tomography arthrography, may accurately depict major wrist ligamentous injury. Dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction. There is a growing evidence base for the diagnostic accuracy of these techniques in detecting intrinsic ligament tears, but there are limitations. Evidence of their efficacy and relevance in detection of non-dissociative carpal instability and extrinsic ligament tears is weak. Further research into the accuracy of existing imaging modalities is still required. Novel techniques, including four-dimensional computerized tomography and magnetic resonance, can evaluate both cross-sectional and functional carpal anatomy. This is a narrative review of level-III studies evaluating the role of imaging in carpal instability.
Collapse
Affiliation(s)
- N K Ramamurthy
- Department of Radiology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A J Chojnowski
- Department of Orthopaedic Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| |
Collapse
|
61
|
Shahabpour M, Staelens B, Van Overstraeten L, De Maeseneer M, Boulet C, De Mey J, Scheerlinck T. Advanced imaging of the scapholunate ligamentous complex. Skeletal Radiol 2015. [PMID: 26219592 DOI: 10.1007/s00256-015-2182-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.
Collapse
Affiliation(s)
- Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Barbara Staelens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Thierry Scheerlinck
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| |
Collapse
|
62
|
Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now. Eur Radiol 2015; 26:1221-5. [PMID: 26253260 DOI: 10.1007/s00330-015-3945-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/09/2015] [Accepted: 07/23/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. KEY POINTS • Intra-articular contrast agent injection can be performed using different imaging modalities • Fluoroscopy is widely used, but uses ionizing radiation • Ultrasound is an accurate, quick, and radiation-free modality for joint injection • X-rays should be avoided when other radiation-free modalities can be used.
Collapse
|
63
|
|
64
|
Abstract
Acute treatment of scapholunate instability is important to prevent future complications of dorsal intercalated segment instability and scapholunate advanced collapse. An understanding of the fundamental normal and abnormal mechanics of this problem is vital. Diagnosis in the acute phase is based on clinical and radiographic findings and treatment focuses on primary scapholunate interosseous ligament repair with a reinforcing dorsal capsulodesis. Suture anchor repair with a modified "double-dorsal" capsulodesis is described. Current data show that open repair is a viable option in the acute setting with most patients demonstrating good to excellent functional, clinical, and radiographic results.
Collapse
Affiliation(s)
- Morgan M Swanstrom
- Hospital for Special Surgery, Hand and Upper Extremity Service, 523 East 72nd Street, New York, NY 10021, USA
| | - Steve K Lee
- Hospital for Special Surgery, Hand and Upper Extremity Service, 523 East 72nd Street, New York, NY 10021, USA.
| |
Collapse
|
65
|
Langner I, Fischer S, Eisenschenk A, Langner S. Cine MRI: a new approach to the diagnosis of scapholunate dissociation. Skeletal Radiol 2015; 44:1103-10. [PMID: 25761726 DOI: 10.1007/s00256-015-2126-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the feasibility of cine MRI for the detection of scapholunate dissociation (SLD) and to compare the sensitivity and specificity of cine MRI with those of cineradiography and arthroscopy. MATERIALS AND METHODS To evaluate feasibility, healthy subjects underwent cine MRI of the wrist. To evaluate sensitivity and specificity, patients with clinically suspected scapholunate ligament (SLL) injury after trauma to the wrist were prospectively included and underwent radiographic examination, cineradiography, and cine MRI. In 25 out of 38 patients, subsequent arthroscopy was performed. Results of cineradiography and cine MRI correlated with those of arthroscopy. RESULTS Cine MRI was of diagnostic quality in all healthy subjects and patients with good interrater agreement. There was excellent correlation between cineradiography and cine MRI. Scapholunate distance differed significantly between healthy subjects and patients with scapholunate dissociation (p < 0.001), but not between imaging modalities in the patient group. Cine MRI had 85% sensitivity and 90% specificity for the detection of SLD. CONCLUSION Cine MRI of the wrist is a fast and reliable technique for the detection of SLD with diagnostic accuracy comparable to cineradiography. It can be easily implemented as a routine clinical MRI examination, facilitating diagnostic workup of patients with suspected SLD while avoiding radiation exposure.
Collapse
Affiliation(s)
- I Langner
- Division of Hand Surgery and Functional Microsurgery, Department of Trauma and Reconstructive Surgery, University Medicine Greifswald, Greifswald, Germany
| | | | | | | |
Collapse
|
66
|
Cody ME, Nakamura DT, Small KM, Yoshioka H. MR Imaging of the Triangular Fibrocartilage Complex. Magn Reson Imaging Clin N Am 2015. [DOI: 10.1016/j.mric.2015.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
67
|
Dallaudière B, Meyer P, Larbi A, Moinard M, Moreau-Durieux MH, Poussange N, Pelé E, Pesquer L. Magnetic resonance arthrography of the wrist with axial traction: An iconographic review. Diagn Interv Imaging 2015; 96:1307-12. [PMID: 26112073 DOI: 10.1016/j.diii.2014.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/16/2022]
Abstract
Stress maneuvers inspired by arthroscopic techniques have been previously studied for MRA of shoulder, hip, knee and wrist. Axial traction in MRA of the wrist is advantageous to study intrinsic ligaments and cartilage, but seems useless to assess tendons or nerves disorders. Based on our experience and a well-chosen iconography, we would like to emphasize the contribution of axial traction in MRA of wrist disorders.
Collapse
Affiliation(s)
- B Dallaudière
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France; CHU Pellegrin, service de radiologie, département d'imagerie musculosquelettique, place Amélie-Léon-Rabat, 33000 Bordeaux, France.
| | - P Meyer
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - A Larbi
- Service de radiologie, département d'imagerie musculosquelettique, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - M Moinard
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - M-H Moreau-Durieux
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - N Poussange
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - E Pelé
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - L Pesquer
- Centre d'imagerie ostéoarticulaire, clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| |
Collapse
|
68
|
Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR. The Traumatized TFCC: An Illustrated Review of the Anatomy and Injury Patterns of the Triangular Fibrocartilage Complex. Curr Probl Diagn Radiol 2015; 45:39-50. [PMID: 26117527 DOI: 10.1067/j.cpradiol.2015.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
Abstract
The triangular fibrocartilage complex (TFCC) plays an important role in wrist biomechanics and is prone to traumatic and degenerative injury, making it a common source of ulnar-sided wrist pain. Because of this, the TFCC is frequently imaged, and a detailed understanding of its anatomy and injury patterns is critical in generating an accurate report to help guide treatment. In this review, we provide a detailed overview of TFCC anatomy, its normal appearance on magnetic resonance imaging, the spectrum of TFCC injuries based on the Palmer classification system, and pitfalls in accurate assessment.
Collapse
Affiliation(s)
- Matthew R Skalski
- Department of Radiology, Southern California University of Health Sciences, Whittier, CA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Aaron J Schein
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hector RiveraMelo
- Department of Radiology, Southern California University of Health Sciences, Whittier, CA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| |
Collapse
|
69
|
Coert JH, Hoogvliet P, Rinkel WD. Hand examination and investigations. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
70
|
Kirchberger MC, Unglaub F, Mühldorfer-Fodor M, Pillukat T, Hahn P, Müller LP, Spies CK. Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 2015; 135:427-37. [PMID: 25575720 DOI: 10.1007/s00402-015-2153-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 02/09/2023]
Abstract
The TFCC is a crucial stabilizer of the DRUJ. Based on its superficial and deep fibers, the TFCC guarantees unrestricted pronation and supination which is essential for performing sophisticated tasks. The ability to perform complex movements is of uppermost importance for hand function. Therefore, a functional intact TFCC is a prerequisite in this context. The articular disc of the TFCC is a fibrocartilaginous extension of the superficial zone of hyaline articular cartilage which arises from the radius. The peripheral 10-40 % of the TFC is vascularized. Degeneration of the articular disc is common with increasing age. Even though the central part of the articular disc is avascular, potential regeneration of lesions could be detected. The Palmer and Atzei classifications of TFCC lesions are complementary. TFCC innervation is based on different nerves. There is a high variability. A diligent clinical examination facilitates specific tests which help to allocate symptoms to the pathology. Therefore, a thorough clinical examination is not dispensable. Wrist arthroscopy remains the "gold standard" for diagnosing TFCC pathologies despite technical progress in imaging modalities. MR arthrography may have the potential to become a real alternative to wrist arthroscopy for diagnosing TFCC pathologies with technical progress in the future.
Collapse
Affiliation(s)
- Michael C Kirchberger
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
| | | | | | | | | | | | | |
Collapse
|
71
|
Lok RLK, Griffith JF, Ng AWH, Wong CWY. Imaging of radial wrist pain. Part II: pathology. Skeletal Radiol 2014; 43:725-43. [PMID: 24522772 DOI: 10.1007/s00256-014-1826-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/06/2014] [Accepted: 01/11/2014] [Indexed: 02/02/2023]
Abstract
Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities.
Collapse
Affiliation(s)
- Ryan Lee Ka Lok
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Shatin, Hong Kong,
| | | | | | | |
Collapse
|
72
|
Abstract
MRI has been established as an essential tool for accurate diagnosis in patients with musculoskeletal trauma. Its major advantages include excellent soft tissue contrast, high spatial resolution and lack of ionizing radiation. Although plain radiographs remain the basic tool for diagnosis and treatment planning in bone fractures assisted by CT in pelvic, spine and large joints injuries, there are specific circumstances that require MRI. For instance, tendinous, ligamentous, intraarticular structures such as the cartilage and menisci, and intramedullary injury are seen mostly with MRI. Volumetric 3D techniques are now commercially available and provide higher spatial resolution which improves anatomic detail, allows multiplanar reformations and reduces the acquisition time. Newer applications on quantitative rather than morphologic imaging, such as relaxometry and diffusion tensor imaging, may be of paramount importance in treatment planning in the near future. Software improvements reduce metal induced artefacts, allowing thus imaging of the postoperative patient with metallic implants. A tendency towards a structured reporting pattern and standardised medical communication needs to be further explored for the benefit of orthopaedic surgeons, radiologists and patients.
Collapse
|