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Stensby JD, Fox MG, Nacey N, Blankenbaker DG, Frick MA, Jawetz ST, Raizman NM, Said N, Stephens LA, Subhas N, Walker EA, Wright CL, Chang EY. ACR Appropriateness Criteria® Chronic Hand and Wrist Pain: 2023 Update. J Am Coll Radiol 2024; 21:S65-S78. [PMID: 38823956 DOI: 10.1016/j.jacr.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Chronic hand and wrist pain is a common presenting complaint. The intricate anatomy results in a variety of pain generators-multiple bones, articular cartilage, intrinsic ligaments, triangular fibrocartilage complex, joint capsules and synovium, tendons and tendon sheaths, muscles, and nerves-in a compact space. The need for imaging and the choice of the appropriate imaging modality are best determined by the patient's presentation, physical examination, and the clinician's working differential diagnosis. Radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Nicholas Nacey
- Panel ViceChair, University of Virginia Health System, Charlottesville, Virginia
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; American Academy of Orthopaedic Surgeons
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Luke A Stephens
- University of Missouri School of Medicine, Columbia, Missouri, Primary care physician
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Chadwick L Wright
- The Ohio State University Wexner Medical Center, Columbus, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Hergár L, Kovács N, Agócs G, Weninger V, Skaliczki G, Lutz E, Hegyi P, Kovács BK, Hetthéssy JR. No evidence for the superiority of 3 T MRI over 1.5 T MRI for diagnosing wrist ligamentous lesions: a systematic review and meta-analysis. Arthroscopy 2024:S0749-8063(24)00335-9. [PMID: 38735416 DOI: 10.1016/j.arthro.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
PURPOSES Our aim was to determine the diagnostic accuracy of native MRI regarding different ligamentous lesions of the wrist and to analyze the influence of technical characteristics, such as field strength, application of fat saturation, 3D sequences, and wrist coils. METHODS The systematic search was performed using MEDLINE, Embase, and CENTRAL databases. Studies that were published before the 12th of February 2024 were included. All studies comparing the diagnostic accuracy of native wrist MRI to that of wrist arthroscopy for suspected ligamentous lesions were included. Results were analyzed by anatomic localization and technical aspects of the MRI. To assess the quality of included studies, we used the revised QUADAS-2 tool. RESULTS The systematic search revealed 5,181 articles. Thirty-seven studies, reporting 3893 ligamentous lesions, were eligible for inclusion. The studies displayed heterogeneity in terms of technical conditions, such as field strength, the use of wrist coils, the application of 3D sequences and fat saturation. Research methods also varied. Overall sensitivity and specificity were 0.78 (0.66 - 0.86) and 0.81 (0.70 - 0.89) for 1.5T MRI, while sensitivity was 0.73 (0.68 - 0.78) and specificity was 0.90 (0.59 - 0.98) for 3T MRI. There was no significant difference between the two subgroups (p=0,3807 and p=0,4248). Sensitivity was 0.82 (0.75 - 0.87) for triangular fibrocartilage complex (TFCC) lesions, 0.63 (0.50 - 0.74) for scapholunate ligament (SL) tears, and 0.41 (0.25 - 0.60) for lunotriquetral ligament (LT) lesions. Specificity for TFCC lesions was 0.82 (0.73 - 0.89), for SL tears 0.86 (0.73 - 0.93), and for LT lesions 0.93 (0.81 - 0.98). CONCLUSION The sensitivity and specificity of MRI is influenced by the anatomic location of the lesion and technical conditions. In terms of diagnostic accuracy, no significant difference was found between 1.5T and 3T MRI. LEVEL OF EVIDENCE III. Systematic review of Level II. - III. STUDIES
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Affiliation(s)
- Luca Hergár
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - Norbert Kovács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Semmelweis University Department of Biophysics and Radiation Biology.
| | - Viktor Weninger
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - Elmar Lutz
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | | | - Judit Réka Hetthéssy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Hand Clinic, Budapest, Hungary; Research Management Workgroup, Semmelweis University.
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The effect of CT and MRI with and without arthrography on the appearance of the feline carpal ligaments. BMC Vet Res 2022; 18:368. [PMID: 36207745 PMCID: PMC9540734 DOI: 10.1186/s12917-022-03463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background The current diagnosis of feline carpal injuries is based on radiographic examination including stress views and computed tomography; however, these techniques do not allow for direct evaluation of the carpal ligaments. The purpose of this cadaveric study was to assess the ability of CT arthrography (CTA) and MR arthrography (MRA) to provide this information using a single contrast mixture. A protocol for intra-articular injection of the feline carpus was also described. A contrast solution containing gadolinium and iohexol with a 50% gadolinium solution (Magnevist—gadolinium 0.5 mmol/mL diluted to a 0.05 mmol/mL solution) and 50% of iodine (Iohexol—iodine 300mgI/mL) was injected into the antebrachiocarpal and middle carpal joints of feline carpi using fluoroscopic guidance. Results CTA allowed for identification of intra-articular ligaments and the silhouette of select extra-articular ligaments when there was adequate joint distension, however it was not considered to be superior to MRI. MRA allowed for improved identification of the dorsal radiocarpal, accessorioulnocarpal, accessorioquartile, short ulnar and short radial collateral ligaments. Conclusion In this ex-vivo study, combined CTA and MRA enhanced the appearance of the feline carpal ligaments and may provide a foundation for future studies in the diagnosis of carpal injuries. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-022-03463-6.
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Fischer R, Tschudi SB, Schaefer DJ, Kaempfen A. Wrist Arthroscopy Is Effective for the Diagnosis and Treatment of Chronic Wrist Pain in Pediatric Patients. Arthrosc Sports Med Rehabil 2022; 4:e1403-e1408. [PMID: 36033170 PMCID: PMC9402464 DOI: 10.1016/j.asmr.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the outcomes of diagnostic and therapeutic arthroscopy in patients with chronic wrist pain who are younger than 16 years of age. Methods We retrospectively analyzed collected data from medical records of patients who had undergone wrist arthroscopy by the senior author between 2015 and 2017 for longstanding wrist pain and were 16 years old or younger. Findings from preoperative magnetic resonance imaging (MRI) were compared with the intraoperative diagnosis, and midterm results were gathered by a telephone interview. Results Ten patients were included. Eight of 10 patients had undergone conservative therapy before surgery, and 60% had a history of single trauma. In 6 of 10 patients, the arthroscopic diagnosis correlated with the MRI findings. Eight of 10 wrists (80%) showed a tear of the triangular fibrocartilage complex (TFCC). Only 4 of the 8 TFCC tears were correctly identified by 3-Tesla MRI. Conclusions In our study, wrist arthroscopy was an effective tool not only to diagnose but also to treat relevant TFCC lesions both in adolescents and children suffering from persistent wrist pain. A 3-Tesla MRI was neither sensitive nor specific enough to correctly diagnose lesions in small pediatric wrists. Level of Evidence IV, Therapeutic case series.
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Affiliation(s)
| | - Samuel B. Tschudi
- Address correspondence to Dr. Med. Samuel Tschudi, M.D., Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Spitalstr. 21, 4031 Basel, Switzerland.
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Radio-carpal wrist MR arthrography: comparison of ultrasound with fluoroscopy and palpation-guided injections. Skeletal Radiol 2022; 51:765-775. [PMID: 34324016 DOI: 10.1007/s00256-021-03845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ultrasound- (US), fluoroscopy- (FL), and palpation-guided contrast injection techniques used for dorsal radio-carpal wrist MRA. MATERIALS AND METHODS Patients with chronic wrist pain were randomized as to which injection technique they underwent into three groups of 50 participants. Dorsal radio-carpal contrast injection was performed under US, FL guidance (one radiologist for each), or palpation guidance by an orthopedic surgeon. The three techniques were compared by procedure time, success rate, number of attempts needed, frequency and grade of extravasation, joint distension, and MRA image quality. Additionally, any change from baseline wrist pain was recorded using the visual analog scale (VAS) at five time points (immediately, 8 h, 24 h, 48 h, and 1 week) after injection. RESULTS One hundred and fifty patients (83 males and 67 females; mean age 29 ± 6.5 years) were included. Success rates for US- and FL-guided injections were 100%, while palpation-guided approach was significantly less successful (72%) (P = 0.02) with significantly more frequent extravasation (56%)(P < 0.001). US guidance was the least time-consuming (6.5 ± 1.6 min) compared to FL guidance (12.5 ± 1.9 min) and palpation guidance (8 ± 1.2 min) (all P < 0.001). The mean number of joint puncture attempts was significantly lower with imaging-guided techniques (1.1 ± 0.24 and 1.2 ± 0.4 for US and FL, P = 0.23) compared to palpation-guided one (1.6 ± 0.8) (P = 0.007). The largest increases in baseline-pain were 8-h post-injection, and US guidance was the least painful at all-time points (all P < 0.05). Joint distension and image quality were significantly better with imaging-guided techniques (P < 0.001 and P = 0.003). CONCLUSIONS US-guided radio-carpal injection is a less time-consuming, more tolerable, and successful radiation-free method when compared to FL guidance. Palpation-guided injections require multiple attempts to enter the joint with high failure rates and frequent extravasation.
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Terzis A, Klinger A, Seegmüller J, Sauerbier M. Inter-Rater Reliability of Magnetic Resonance Imaging in Comparison to Computed Tomography and Wrist Arthroscopy in SLAC and SNAC Wrist. J Clin Med 2021; 10:3592. [PMID: 34441890 PMCID: PMC8397217 DOI: 10.3390/jcm10163592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the inter-rater reliability of magnetic resonance imaging (MRI) in comparison to computed tomography (CT) and wrist arthroscopy in patients with scapholunate (SLAC) or scaphoid non-union advanced collapse (SNAC) as well as to evaluate a grading score of cartilage lesions. A total of 42 patients (36 male, 6 female) at a mean age of 45 years (range: 19-65 years) with a SLAC or SNAC wrist who had a preoperative MRI and CT scan as well as underwent arthroscopy of the wrist between 2013 and 2018 were included in this study. Cartilage lesions, as assessed by MRI, CT and wrist arthroscopy, were classified by two hand surgeons in three stages. Inter-rater reliability was evaluated using the Kendall Tau-b test as well as the chi-square test to analyze for trend. The correlation between cartilage lesions, classified by arthroscopy and MRI, was low. A moderate correlation between CT and arthroscopy staging was shown. The highest inter-rater correlation was found between MRI and CT staging. An additionally performed logistic regression showed that progression of cartilage lesions as shown in MRI scans correlates with a restriction of range of motion (ROM). The level of cartilage lesion may be more severely classified in an MRI than during arthroscopy. Arthroscopy remains the gold standard in detecting cartilage lesions and thus in the decision-making process of the definitive treatment in carpal collapse.
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Affiliation(s)
- Athanasios Terzis
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Arlena Klinger
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Jessica Seegmüller
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Michael Sauerbier
- Private Practice for Hand and Plastic Surgery, 61348 Bad Homburg v. d. Höhe, Germany;
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Abstract
Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called "scapholunate complex" has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).
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Abstract
Technological advances in magnetic resonance imaging (MRI) have improved radiologists' ability to evaluate wrist ligaments. MRI interpretation often guides clinical management. This article aims to review the normal and pathologic appearance of intrinsic and extrinsic wrist ligaments with a focus on MRI. Variant anatomy, imaging pearls, and clinical significance are also discussed. Special attention is paid to key wrist ligaments that play a role in carpal stability.
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Lee HS, Lee YH, Jung I, Song OK, Kim S, Song HT, Suh JS. Optimization of MRI Protocol for the Musculoskeletal System. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:21-40. [PMID: 36238123 PMCID: PMC9432082 DOI: 10.3348/jksr.2020.81.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/05/2022]
Abstract
자기공명영상(magnetic resonance imaging; 이하 MRI)은 다른 영상 기법에 비해 연부 조직 대조도와 해상력이 높아 근골격계 영역에서 중요한 진단 기기로 이용되고 있다. 최근 MRI 관련 기술이 발달함에 따라 빠른 영상 촬영 및 다양한 영상면 재구성이 가능해짐으로써 입체적인 근골격계 해부학적 구조와 병변을 더욱 잘 평가할 수 있게 되었다. 또한, MRI는 최적화 정도에 따라 영상의 질, 진단 정확도 및 촬영 시간 등이 달라지며, MRI 장치의 효율적 인 운용과도 관련이 있어, 이를 관리하는 것은 영상의학과 의사의 중요한 역할이다. 본 종설에서는 6개 주요 관절에 따른 환자 자세, radiofrequency 코일 선택, 권장 펄스열, 영상면 구성 및 스캔 파라미터에 대한 지침을 제시함으로써 근골격계 MRI의 최적화에 도움이 되고자 한다.
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Affiliation(s)
- Hong Seon Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Inha Jung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Ok Kyu Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
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Dreckmann SC, von Schroeder HP, Novak CB, Baltzer HL. Utility of Specialized Imaging for Diagnosis of Chronic Wrist Pain. J Wrist Surg 2019; 8:497-502. [PMID: 31815065 PMCID: PMC6892649 DOI: 10.1055/s-0039-1697022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Background Patients with chronic wrist pain often undergo imaging (such as magnetic resonance imaging [MRI], computed tomography [CT], or ultrasound [US]) prior to specialist assessment. Questions Is specialized wrist imaging performed prior to expert consultation necessary? Are there demographic differences between patients who do or do not receive preconsultation imaging? Patients and Methods A total of 115 patients referred to a tertiary hand center for chronic wrist pain and assessed by a hand surgeon were included. At initial consultation, surgeons were blinded to referral information and previous imaging results. The specialist performed a history, physical examination and reviewed X-rays. They established a clinical diagnosis and whether any additional investigations were needed. Prior MRI, CT, and/or US results were then reviewed and the specialists' clinical diagnosis was compared with the blinded referral diagnosis. Preconsultation imaging was categorized as having no value for diagnosis/management, some value, or high value. Results A total of 82 patients had imaging prior to specialist referral (69 MRIs, 11 CTs, and 16 ultrasounds). The majority of additional imaging (73%) was classified as unnecessary, including 77% of the MRIs and 100% of the ultrasounds. Of all the investigations performed, two CT scans were labeled highly valuable clinical aids. Older patients and those with radial-sided pain were less likely to receive preconsultation imaging. Six patients required further imaging after consultation. Conclusion Clinical assessment and X-rays are typically sufficient for a hand specialist to diagnose and manage chronic wrist pain and few patients require additional imaging. Level of Evidence This is a Level III study.
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Affiliation(s)
- Stephanie C. Dreckmann
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Herbert P. von Schroeder
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christine B. Novak
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Heather L. Baltzer
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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Omar NN, Mahmoud MK, Saleh WR, Almallah HG, Qenawy OK, Mourad AF, Abdul Monem ES. MR arthrography versus conventional MRI and diagnostic arthroscope in patients with chronic wrist pain. Eur J Radiol Open 2019; 6:265-274. [PMID: 31372370 PMCID: PMC6657234 DOI: 10.1016/j.ejro.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/17/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain. Materials and methods 37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years "mean age 28 years" complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion. Results MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically. Conclusion MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain.
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Affiliation(s)
- Nagham Nabil Omar
- Radiodiagnosis department, Assuit university, faculty of medicine, Egypt
| | | | - Waleed Riad Saleh
- Orthopedics department, Assuit university, faculty of medicine, Assuit, Egypt
| | | | | | - Amro Farouk Mourad
- Radiodiagnosis department, Assuit university, South Egypt national institute, Assuit, Egypt
| | - Eman Sayed Abdul Monem
- radiodiagnosis department, Egyptian ministry of health, Aleman general hospital, Assuit, Egypt
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Torabi M, Lenchik L, Beaman FD, Wessell DE, Bussell JK, Cassidy RC, Czuczman GJ, Demertzis JL, Khurana B, Klitzke A, Motamedi K, Pierce JL, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16:S7-S17. [DOI: 10.1016/j.jacr.2019.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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Mehta NH, Garg B, Ansari T, Srivastava DN, Kotwal PP. Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population. Indian J Orthop 2019; 53:769-775. [PMID: 31673180 PMCID: PMC6804379 DOI: 10.4103/ortho.ijortho_92_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. MATERIALS AND METHODS Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures - triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). RESULTS For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. CONCLUSIONS The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.
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Affiliation(s)
- Nishank H Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Bhavuk Garg, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash P Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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14
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Treiser MD, Crawford K, Iorio ML. TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities. J Wrist Surg 2018; 7:267-272. [PMID: 29922507 PMCID: PMC6005773 DOI: 10.1055/s-0038-1629911] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
Background Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity. Purpose This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries. Methods A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the "gold standard." A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries. Results Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72-0.80), 0.78(0.70-0.84), and 0.89 (0.81-0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77-0.86), 0.85 (0.77-0.92), and 0.89 (0.81-0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions. Conclusion This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.
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Affiliation(s)
- Matthew D. Treiser
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kayva Crawford
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Plastic and Reconstructive Surgery, University of Colorado Medical Center, Aurora, Colorado
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15
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Maloney E, Zbojniewicz AM, Nguyen J, Luo Y, Thapa MM. Anatomy and injuries of the pediatric wrist: beyond the basics. Pediatr Radiol 2018; 48:764-782. [PMID: 29557490 DOI: 10.1007/s00247-018-4111-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Ligamentous injuries of the pediatric wrist, once thought to be relatively uncommon, are increasingly recognized in the context of acute high-energy mechanism trauma and chronic axial loading, including those encountered in both recreational and high-performance competitive sports. Recent advances in MR-based techniques for imaging the pediatric wrist allow for sensitive identification of these often radiographically occult injuries. Detailed knowledge of the intrinsic and supportive extrinsic ligamentous complexes, as well as normal developmental anatomy and congenital variation, are essential to accurately diagnose injuries to these structures. Early identification of ligamentous injury of the pediatric wrist is essential within the conservative treatment culture of modern pediatric orthopedics because treatment of these lesions often necessitates surgery, and outcomes often depend on early and sometimes aggressive intervention. In this article, we review MR arthrogram technique and pediatric wrist anatomy, and correlate appearances on MR and selected ligamentous pathologies of the pediatric wrist.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Andrew M Zbojniewicz
- Division of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, College of Human Medicine, Helen DeVos Children's Hospital, Advanced Radiology Services, Michigan State University, Grand Rapids, MI, USA
| | - Jie Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yu Luo
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, TN, USA
| | - Mahesh M Thapa
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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16
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ACR Appropriateness Criteria ® Chronic Wrist Pain. J Am Coll Radiol 2018; 15:S39-S55. [DOI: 10.1016/j.jacr.2018.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/12/2023]
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17
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Rubensson C, Johansson T, Adolfsson L. Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability. J Hand Surg Eur Vol 2018; 43:369-374. [PMID: 29448916 DOI: 10.1177/1753193418756805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED During 1994-2003, we treated 20 patients with post-traumatic radial-sided wrist pain and dynamic radiocarpal instability. After arthroscopy confirmed no disruption of the radioscaphocapitate ligament and an increased laxity of the ligament, we passed a strip of the radioscaphocapitate ligament through the long radio-lunate ligament. The rationale of this procedure was to increase tension of the two ligaments and to close the space of Poirier. Eighteen patients were assessed after 1-3.7 years (mean 2.5 years). Four patients were symptom-free and 11 patients were markedly improved. Fourteen patients were followed for 11-15 years; four patients were symptom-free and eight patients were markedly improved. Two reported unchanged symptoms and none was worse in the follow-up. Based on our findings, we suggest a cause of post-traumatic radial-sided wrist pain is laxity of the radiocarpal joint. We conclude that our surgical procedure increases tension in the radioscaphocapitate and long radio-lunate ligaments and decreases wrist pain at rest and during activity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Carin Rubensson
- 1 Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden.,2 Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Torsten Johansson
- 2 Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,3 Department of Orthopedics, Linköping University, Linköping, Sweden
| | - Lars Adolfsson
- 2 Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,3 Department of Orthopedics, Linköping University, Linköping, Sweden
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18
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Boer BC, Vestering M, van Raak SM, van Kooten EO, Huis In 't Veld R, Vochteloo AJH. MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1549-1553. [PMID: 29700613 PMCID: PMC6244851 DOI: 10.1007/s00590-018-2215-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
Introduction In case of clinical suspicion of triangular fibrocartilage complex (TFCC) injury, different imaging techniques are used. The aim of this study was to determine whether MRA is superior to MRI and whether 3.0 T is better than 1.5 T (expresses in sensitivity, specificity and accuracy) in detecting TFCC injury, using arthroscopy as the gold standard. Materials and methods The arthroscopic and MR findings of 150 patients who underwent arthroscopy for ulnar-sided wrist pain between January 2009 and November 2016 were retrospectively reviewed. Results MRA was slightly more accurate compared to conventional MRI, and 1.5 T was slightly more accurate than 3.0 T. 1.5 T wrist MRA had a sensitivity of 80%, a specificity of 100% and accuracy of 90%; 3.0 T wrist MRA 73, 100 and 86%, resp. Conventional 1.5 T wrist MRI had a sensitivity of 71%, a specificity of 75% and accuracy of 73%. For 3.0 T conventional MRI, this was 73, 67 and 70%, resp. Conclusions MRA seems slightly superior to conventional MRI, but one could question whether this difference in diagnostic accuracy outweighs the burden and risks of an invasive procedure for patients with its additional costs. Furthermore, we could not confirm the superiority of 3 T compared to 1.5 T.
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Affiliation(s)
- B C Boer
- Hand and Wrist Unit, Centre for Orthopaedic Surgery OCON, PO Box 546, 7550 AM, Hengelo, The Netherlands
| | - M Vestering
- Department of Radiology, Ziekenhuisgroep Twente, PO Box 546, 7550 AM, Hengelo, The Netherlands.,Department of Radiology, Medisch Spectrum Twente, Postbus 50 000, 7500 KA, Enschede, The Netherlands
| | - S M van Raak
- Department of Radiology, Ziekenhuisgroep Twente, PO Box 546, 7550 AM, Hengelo, The Netherlands
| | - E O van Kooten
- Department of Plastic Surgery, Medisch Spectrum Twente, Postbus 50 000, 7500 KA, Enschede, The Netherlands
| | - R Huis In 't Veld
- Hand and Wrist Unit, Centre for Orthopaedic Surgery OCON, PO Box 546, 7550 AM, Hengelo, The Netherlands
| | - A J H Vochteloo
- Hand and Wrist Unit, Centre for Orthopaedic Surgery OCON, PO Box 546, 7550 AM, Hengelo, The Netherlands.
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19
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Abstract
The distal radioulnar joint, the triangular fibrocartilage complex (TFCC) and the wrist are stabilized by many ligaments allowing not only a wide range of motion but also providing sufficient stability. The complex arrangement of carpal ligaments and prosupination around the forearm joint enables multiaxial motion patterns. In the wrist, intra-articular ligaments can be differentiated from extra-articular capsular ligaments as well as intrinsic and extrinsic ligament courses. Imaging is essential for classification of dynamic and static instability patterns. This review article illustrates the ligamentous anatomy of the wrist, the symptoms of carpal instability as well as the diagnostic capability of projection radiography, cinematography, computed tomography (CT) arthrography, magnetic resonance imaging (MRI) and MR arthrography.
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Affiliation(s)
- R Schmitt
- Herz- und Gefäßklinik GmbH Bad Neustadt, Salzburger Leite 1, 97616, Bad Neustadt, Deutschland.
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20
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Ng AWH, Griffith JF, Fung CSY, Lee RKL, Tong CSL, Wong CWY, Tse WL, Ho PC. MR imaging of the traumatic triangular fibrocartilaginous complex tear. Quant Imaging Med Surg 2017; 7:443-460. [PMID: 28932701 DOI: 10.21037/qims.2017.07.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cindy S Y Fung
- Department of Diagnostic Imaging, North District Hospital, Hong Kong, China
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Clara W Y Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Lim Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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21
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Asaad AM, Andronic A, Newby MP, Harrison JWK. Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain. J Hand Surg Eur Vol 2017; 42:580-585. [PMID: 28488454 DOI: 10.1177/1753193417695180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We reviewed a series of 50 consecutive wrist arthroscopy patients who had been investigated pre-operatively by direct magnetic resonance arthrography and calculated the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of magnetic resonance arthrography in detecting full-thickness triangular fibrocartilage complex tears, intrinsic carpal ligamentous lesions, wrist synovitis and chondral lesions in the radiocarpal joint. The sensitivities of magnetic resonance arthrography in detecting central triangular fibrocartilage complex tears, peripheral triangular fibrocartilage complex tears, scapholunate ligament tears, lunotriquetral ligament tears, dorsal synovitis and radiocarpal chondral lesions were 89%, 63%, 71%, 100%, 32% and 65%, respectively, and its specificities in detecting these lesions were 91%, 98%, 89%, 94% 94% and 97%, respectively. This study suggests that single compartment direct wrist magnetic resonance arthrography can provide high diagnostic accuracy for full-thickness triangular fibrocartilage lesions, intrinsic carpal ligament tears and chondral lesions in the radiocarpal joint, but that it is much less accurate in diagnosing synovitis of the radiocarpal joint. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A M Asaad
- Queen Elizabeth Hospital, Gateshead, UK
| | | | - M P Newby
- Queen Elizabeth Hospital, Gateshead, UK
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22
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Cheriex KCAL, Sulkers GSI, Terra MP, Schep NWL, van Aard BJPL, Strackee SD. Scapholunate dissociation; diagnostics made easy. Eur J Radiol 2017. [PMID: 28624019 DOI: 10.1016/j.ejrad.2017.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Scapholunate dissociation (SLD) is a form of carpal instability, caused by rupture of the scapholunate ligament (SLL) the secondary stabiliser of the scapholunate (SL) compartment. SLD can cause osteoarthritis of the wrist. Recently a study was published that shows cineradiography to be an excellent radiological imaging technique for diagnosing SLD at a tertiary centre for hand and wrist surgery [1]. As the quality of these results can be influenced by the expertise of the operator and observer of the cineradiographic studies, the aim of this study was to determine if these results were reproducible at a secondary centre for hand and wrist surgery with less expertise in wrist cineradiography. All cineradiographic studies carried out during a 10-year period were obtained. All patients who underwent the gold standard procedure (arthroscopy/arthrotomy) after cineradiography were included, a total of 50 patients. The diagnostic accuracy of detecting SLD by both cineradiography and conventional radiography was calculated. Cineradiography had a high diagnostic accuracy, while the accuracy for conventional radiography was average. When all wrists with an SL distance ≥3mm were excluded (static SLD), diagnostic accuracy for conventional radiography dropped even lower, while accuracy for cineradiography remained high. These results are comparable with published accuracy rates and show that cineradiography has a high diagnostic value for detecting SLD and do not seem to be influenced by the operator or observer of the cineradiographic studies.
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Affiliation(s)
- K C A L Cheriex
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouw Gasthuis Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - G S I Sulkers
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - M P Terra
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - N W L Schep
- Trauma Unit, Department of surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
| | - B J P L van Aard
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouw Gasthuis Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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23
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Oh E, Yoon YC, Park MJ. Diagnostic performance of wrist magnetic resonance (MR) arthrography: comparison of three-dimensional isotropic T 1 weighted fast spin-echo MR arthrography and two-dimensional MR arthrography. Br J Radiol 2017; 90:20160867. [PMID: 28079395 DOI: 10.1259/bjr.20160867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T1 weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T1 weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears. METHODS 26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T1 weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated. RESULTS Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent. CONCLUSION In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T1 weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T1 weighted FSE D-MRA and that of 2D T1 weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T1 weighted FSE D-MRA has potential for substituting 2D imaging.
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Affiliation(s)
- Eunsun Oh
- 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young C Yoon
- 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min J Park
- 2 Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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24
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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]
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25
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Sutherland JK, Nozaki T, Kaneko Y, J Yu H, Rafijah G, Hitt D, Yoshioka H. Initial experience with 3D isotropic high-resolution 3 T MR arthrography of the wrist. BMC Musculoskelet Disord 2016; 17:30. [PMID: 26772813 PMCID: PMC4715345 DOI: 10.1186/s12891-016-0890-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background Our study was performed to evaluate the image quality of 3 T MR wrist arthrograms with attention to ulnar wrist structures, comparing image quality of isotropic 3D proton density fat suppressed turbo spin echo (PDFS TSE) sequence versus standard 2D 3 T sequences as well as comparison with 1.5 T MR arthrograms. Methods Eleven consecutive 3 T MR wrist arthrograms were performed and the following sequences evaluated: 3D isotropic PDFS, repetition time/echo time (TR/TE) 1400/28.3 ms, voxel size 0.35x0.35x0.35 mm, acquisition time 5 min; 2D coronal sequences with slice thickness 2 mm: T1 fat suppressed turbo spin echo (T1FS TSE) (TR/TE 600/20 ms); proton density (PD) TSE (TR/TE 3499/27 ms). A 1.5 T group of 18 studies with standard sequences were evaluated for comparison. All MR imaging followed fluoroscopically guided intra-articular injection of dilute gadolinium contrast. Qualitative assessment related to delineation of anatomic structures between 1.5 T and 3 T MR arthrograms was carried out using Mann–Whitney test and the differences in delineation of anatomic structures among each sequence in 3 T group were analyzed with Wilcoxon signed-rank test. Quantitative assessment of mean relative signal intensity (SI) and relative contrast measurements was performed using Wilcoxon signed-rank test. Results Mean qualitative scores for 3 T sequences were significantly higher than 1.5 T (p < 0.01), with isotropic 3D PDFS sequence having highest mean qualitative scores (p < 0.05). Quantitative analysis demonstrated no significant difference in relative signal intensity among the 3 T sequences. Significant differences were found in relative contrast between fluid-bone and fluid-fat comparing 3D and 2D PDFS (p < 0.01). Conclusions 3D isotropic PDFS sequence showed promise in both qualitative and quantitative assessment, suggesting this may be useful for MR wrist arthrograms at 3 T. Primary reasons for diagnostic potential include the ability to make reformations in any obliquity to follow the components of ulnar side wrist structures including triangular fibrocartilage complex. Additionally, isotropic imaging provides thinner slice thickness with less partial volume averaging allowing for identification of subtle injuries.
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Affiliation(s)
- John K Sutherland
- University of California, Irvine, Department of Radiological Sciences, UCI Medical Center 101 The City Dr. South, Route 140, Orange, CA, 92686, USA.
| | - Taiki Nozaki
- University of California, Irvine, Department of Radiological Sciences, UCI Medical Center 101 The City Dr. South, Route 140, Orange, CA, 92686, USA.
| | - Yasuhito Kaneko
- University of California, Irvine, Department of Radiological Sciences, UCI Medical Center 101 The City Dr. South, Route 140, Orange, CA, 92686, USA.
| | - Hon J Yu
- University of California, Irvine, Department of Radiological Sciences and John Tu and Thomas Yuen Center for Functional Onco-Imaging Irvine, Irvine, CA, USA.
| | - Gregory Rafijah
- University of California, Irvine, Department of Orthopaedic Surgery, Irvine, USA.
| | - David Hitt
- Philips Medical Systems, Cleveland, OH, USA.
| | - Hiroshi Yoshioka
- University of California, Irvine, Department of Radiological Sciences, UCI Medical Center 101 The City Dr. South, Route 140, Orange, CA, 92686, USA.
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26
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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.
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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
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Wang ZX, Chen SL, Wang QQ, Liu B, Zhu J, Shen J. The performance of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury: a meta-analysis. J Hand Surg Eur Vol 2015; 40:477-84. [PMID: 25600854 DOI: 10.1177/1753193414567425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate the accuracy of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury through a meta-analysis. A comprehensive literature search was conducted before 1 April 2014. All studies comparing magnetic resonance imaging results with arthroscopy or open surgery findings were reviewed, and 25 studies that satisfied the eligibility criteria were included. Data were pooled to yield pooled sensitivity and specificity, which were respectively 0.83 and 0.82. In detection of central and peripheral tears, magnetic resonance imaging had respectively a pooled sensitivity of 0.90 and 0.88 and a pooled specificity of 0.97 and 0.97. Six high-quality studies using Ringler's recommended magnetic resonance imaging parameters were selected for analysis to determine whether optimal imaging protocols yielded better results. The pooled sensitivity and specificity of these six studies were 0.92 and 0.82, respectively. The overall accuracy of magnetic resonance imaging was acceptable. For peripheral tears, the pooled data showed a relatively high accuracy. Magnetic resonance imaging with appropriate parameters are an ideal method for diagnosing different types of triangular fibrocartilage complex tears.
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Affiliation(s)
- Z X Wang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - S L Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Q Q Wang
- Research Institute of Orthopedics, Beijing Ji Shui Tan Hospital, Beijing, China
| | - B Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - J Zhu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - J Shen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Moritomo H, Arimitsu S, Kubo N, Masatomi T, Yukioka M. Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2015; 40:245-51. [PMID: 25542437 DOI: 10.1016/j.jhsa.2014.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To classify triangular fibrocartilage complex (TFCC) foveal lesions on the basis of computed tomography (CT) arthrography using a radial plane view and to correlate the CT arthrography results with surgical findings. We also tested the interobserver and intra-observer reliability of the radial plane view. METHODS A total of 33 patients with a suspected TFCC foveal tear who had undergone wrist CT arthrography and subsequent surgical exploration were enrolled. We classified the configurations of TFCC foveal lesions into 5 types on the basis of CT arthrography with the radial plane view in which the image slices rotate clockwise centered on the ulnar styloid process. Sensitivity, specificity, and positive predictive values were calculated for each type of foveal lesion in CT arthrography to detect foveal tears. We determined interobserver and intra-observer agreements using kappa statistics. We also compared accuracies with the radial plane views with those with the coronal plane views. RESULTS Among the tear types on CT arthrography, type 3, a roundish defect at the fovea, and type 4, a large defect at the overall ulnar insertion, had high specificity and positive predictive value for the detection of foveal tears. Specificity and positive predictive values were 90% and 89% for type 3 and 100% and 100% for type 4, respectively, whereas sensitivity was 35% for type 3 and 22% for type 4. Interobserver and intra-observer agreement was substantial and almost perfect, respectively. The radial plane view identified foveal lesion of each palmar and dorsal radioulnar ligament separately, but accuracy results with the radial plane views were not statistically different from those with the coronal plane views. CONCLUSIONS Computed tomography arthrography with a radial plane view exhibited enhanced specificity and positive predictive value when a type 3 or 4 lesion was identified in the detection of a TFCC foveal tear compared with historical controls. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Hisao Moritomo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
| | - Sayuri Arimitsu
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Nobuyuki Kubo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takashi Masatomi
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Masao Yukioka
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
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Pahwa S, Srivastava DN, Sharma R, Gamanagatti S, Kotwal PP, Sharma V. Comparison of conventional MRI and MR arthrography in the evaluation wrist ligament tears: A preliminary experience. Indian J Radiol Imaging 2014; 24:259-67. [PMID: 25114389 PMCID: PMC4126141 DOI: 10.4103/0971-3026.137038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: To compare conventional magnetic resonance imaging (MRI) and direct magnetic resonance (MR) arthrography in the evaluation of triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament tears. Materials and Methods: T1-weighted, fat suppressed (FS) proton density plus T2-weighted (FS PD/T2), 3D multiple-echo data image combination (MEDIC) sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL) and lunatotriquetral ligament (LTL) tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard). Results: Sixteen patients underwent arthroscopy/open surgery: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively. Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.
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Affiliation(s)
- Shivani Pahwa
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash P Kotwal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Sharma
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Sulkers GSI, Schep NWL, Maas M, Strackee SD. Intraobserver and interobserver variability in diagnosing scapholunate dissociation by cineradiography. J Hand Surg Am 2014; 39:1050-4.e3. [PMID: 24815911 DOI: 10.1016/j.jhsa.2014.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist cineradiography. METHODS A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. RESULTS The interobserver variability for diagnosing SLD by cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). CONCLUSIONS Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend cineradiography when an SLD is clinically suspected. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- George S I Sulkers
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Niels W L Schep
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Sulkers GSI, Schep NWL, Maas M, van der Horst CMAM, Goslings JC, Strackee SD. The diagnostic accuracy of wrist cineradiography in diagnosing scapholunate dissociation. J Hand Surg Eur Vol 2014; 39:263-71. [PMID: 23697681 DOI: 10.1177/1753193413489056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive cineradiography markedly increases the post-test probability of SLD.
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Affiliation(s)
- G S I Sulkers
- 1Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
The optimal imaging protocols for magnetic resonance imaging (MRI) of the wrist ligaments are discussed, including the use of magnetic resonance arthrography, and 3 Tesla (T) versus 1.5 T magnetic field strength. The normal MRI appearance of the triangular fibrocartilage complex, capsular, and interosseous wrist ligaments is briefly covered to point out potential diagnostic pitfalls. Numerous examples of common ligamentous pathology discernible on MRI are provided, along with the latest estimates of diagnostic sensitivity and specificity provided by the literature.
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Affiliation(s)
- Michael D Ringler
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN.
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Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol 2013; 42:1277-85. [PMID: 23812413 DOI: 10.1007/s00256-013-1666-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/22/2013] [Accepted: 05/28/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE This study compares the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist. MATERIALS AND METHODS Ten cadaveric wrists of five male subjects with an average age 49.6years (range 26-59years) were evaluated using CTA, conventional 3-T MR and MRA. We assessed the presence of scapholunate ligament (SLL), lunotriquetral ligament (LTL), and TFCC tears using a combination of conventional arthrography and arthroscopy as a gold standard. All images were evaluated in consensus by two musculoskeletal radiologists with sensitivity, specificity, and accuracy being calculated. RESULTS Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100%/100%/100%, 66%/86%/80%, 100%/86%/90% for the detection of SLL tear, 100%/80%/90%, 60%/80%/70%, 100%/80%/90% for the detection of LTL tear, and 100%/100%/100%, 100%/86%/90%, 100%/100%/100% for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities. CONCLUSION Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging.
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Cerny M, Marlois R, Theumann N, Bollmann C, Wehrli L, Richarme D, Meuli R, Becce F. 3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears. Eur J Radiol 2013; 82:e582-9. [PMID: 23743056 DOI: 10.1016/j.ejrad.2013.04.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/28/2013] [Accepted: 04/30/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. MATERIALS AND METHODS Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs. RESULTS With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥ 0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025). CONCLUSION The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.
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Affiliation(s)
- Milena Cerny
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Koskinen SK, Haapamäki VV, Salo J, Lindfors NC, Kortesniemi M, Seppälä L, Mattila KT. CT arthrography of the wrist using a novel, mobile, dedicated extremity cone-beam CT (CBCT). Skeletal Radiol 2013; 42:649-57. [PMID: 22990597 DOI: 10.1007/s00256-012-1516-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/17/2012] [Accepted: 08/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility and intra- and interobserver agreement of CBCT arthrography of wrist ligaments, triangular fibrocartilaginous complex (TFCC), and to assess the sensitivity (SE), specificity (SP), accuracy (ACC), and positive and negative predictive value (PPV, NPV) of CBCT arthrography in the diagnosis of scapholunate (SLL) and lunotriquetral (LTL) ligament tears, TFCC, and cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) using a novel, mobile, dedicated extremity CBCT scanner. MATERIALS AND METHODS Fifty-two consecutively enrolled subjects (26 M, 26 F, mean age 38 years, range 18-66 years) with suspected wrist ligament tears underwent CBCT-arthrography before normally scheduled MR arthrography.An extremity CBCT was used for imaging with isotropic voxel size of 0.4 × 0.4 × 0.4 mm(3). Subsequent routine 1.5 T MRI was performed using a dedicated wrist coil.Two observers reviewed the anonymized CBCT images twice for contrast enhancement (CE) and technical details (TD), for tears of the SLL, LTL, and TFCC. Also, cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) were evaluated. Inter- and intraobserver agreement was determined using weighted kappa statistics. Since no surgery was performed, MRI served as a reference standard, and SE and SP, ACC, PPV, and NPV were calculated. RESULTS Intra- and interobserver kappa values for both readers (reader 1/reader 2; first reading/second reading) with 95 % confidence limits were: CE 0.54 (0.08-1.00)/ 0.75 (0.46-1.00); 0.73 (0.29-1.00)/ 0.45 (0.07-0.83), TD 0.53 (0.30-0.88)/ 0.86 (0.60-1.00); 0.56 (0.22-0.91)/ 0.67 (0.37-0.98), SLL 0.59 (0.25-0.93)/ 0.66 (0.42-0.91); 0.31 (0.06-0.56)/ 0.49 (0.26-0.73), LTL 0.83 (0.66-1.00)/ 0.68 (0.46-0.91); 0.90 (0.79-1.00)/ 0.48 (0.22-0.74); TFCC (0.72-1.00)/ (0.79-1.00); 0.65 (0.43-0.87)/ 0.59 (0.35-0.83), radius (scaphoid fossa) 0.45 (0.12-0.77)/ 0.64 (0.31-0.96); 0.58 (0.19-0.96)/ 0.38 (0.09-0.66), scaphoid 0.43 (0.12-0.74)/ 0.76 (0.55-0.96); 0.37 (0.00-0.75)/ 0.32 (0.04-0.59), radius (lunate fossa) 0.68 (0.36-1.00)/ 0.42 (0.00-0.86); 0.62 (0.29-0.96)/ 0.51 (0.12-0.91), and lunate 0.53 (0.16-0.90)/ 0.68 (0.44-0.91); 0.59 (0.29-0.88)/ 0.42 (0.00-0.84), respectively. The overall mean accuracy was 82-92 % and specificity was 81-94 %. Sensitivity for LTL and TFCC tears was 76-83, but for SLL tears it was 58 %. For cartilage abnormalities, the accuracy and negative predictive value were high, 90-98 %. CONCLUSIONS A dedicated CBCT extremity scanner is a new method for evaluating the wrist ligaments and radiocarpal cartilage. The method has an overall accuracy of 82-86 % and specificity 81-91 %. For cartilage abnormalities, the accuracy and negative predictive value were high.
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Affiliation(s)
- Seppo K Koskinen
- Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
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Gray SN, Puchalski SM, Galuppo LD. COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE INTERCARPAL LIGAMENTS OF THE EQUINE CARPUS. Vet Radiol Ultrasound 2013; 54:245-52. [DOI: 10.1111/vru.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/07/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sarah N. Gray
- William R. Pritchard Veterinary Medical Teaching Hospital
| | - Sarah M. Puchalski
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine University of California; Davis 95616; CA
| | - Larry D. Galuppo
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine University of California; Davis 95616; CA
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Abstract
OBJECTIVE The purposes of this review are to describe commonly available 3D MRI techniques and to discuss the literature to date regarding the utility of such techniques in the assessment of internal derangement of joints. CONCLUSION Long acquisition and postprocessing times and limited contrast characteristics have generally prohibited routine use of 3D MRI in clinical practice. However, technical advances, including higher-field-strength MRI systems, high performance gradients, high-resolution multichannel coils, and pulse sequences with shorter acquisition times, have made feasible 3D isotropic MRI with reasonable acquisition times.
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Smith TO, Drew BT, Toms AP, Chojnowski AJ. The diagnostic accuracy of X-ray arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. J Hand Surg Eur Vol 2012; 37:879-87. [PMID: 21467087 DOI: 10.1177/1753193411402762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the diagnostic test accuracy of X-ray arthrography in the detection of TFCC tear. Both published and unpublished databases were searched from their inception to August 2010. All studies comparing the diagnostic accuracy of X-ray arthrography (index test) to arthroscopy (reference standard) for patients with suspected TFCC tears were included in this review. Twelve studies assessing 430 patients (430 wrists) satisfied the eligibility criteria and were included. X-ray arthrography presented with a pooled sensitivity of 76.2% and specificity of 92.5% for the detection of complete TFCC tear. The triple-compartment injection X-ray arthrography was superior to the single-compartment injection technique. To conclude, the diagnostic test accuracy of X-ray arthrography is limited. Neither the single- nor the triple-compartment injection arthrography method is acceptable, given their reported low sensitivities. Further evaluation of the diagnostic test accuracy of Magnetic Resonance Arthrography and Magnetic Resonance Imaging is therefore warranted.
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Affiliation(s)
- T O Smith
- School of Allied Health Professions,University of East Anglia, Norwich, UK.
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Lee YH, Choi YR, Kim S, Song HT, Suh JS. Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging 2012; 31:221-6. [PMID: 22959873 DOI: 10.1016/j.mri.2012.06.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/03/2012] [Accepted: 06/21/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of the study was to validate the diagnostic performance of high-resolution isovolumetric magnetic resonance arthrography (MRA) for intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist as compared to conventional MR imaging (MRI). MATERIALS AND METHODS Forty-eight patients with traumatic TFCC tears at arthroscopy were enrolled. All patients had underwent proton-density- and T2-weighted MRI before arthrography and three-dimensional T1 high-resolution isovolumetric examination (3D-THRIVE) MRA on a 3-T MR. We assessed the presence of scapholunate interosseous ligament (SLIL)/lunotriquetral interosseous ligament (LTIL) or TFCC tears using the arthroscopy as a gold standard. RESULTS Arthroscopy revealed 37 TFCC central tears, 15 TFCC peripheral tears, 20 SLIL tears and 13 LTIL tears. Sensitivities of MRI and MRA were 70.3% and 94.6% for detection of TFCC central tears, 60.0% and 93.3% for detection of TFCC peripheral tears, 65.0% and 85.0% for SLIL tears, and 61.5% and 84.6% for LTIL tears. The specificity of the MRI was 100% for the detection of ligaments and TFCC tears. The specificities of the MRA for detection of TFCC central tears, TFCC peripheral tears, SLIL tears and LTIL tears were 100%, 97%, 96.4% and 100%, respectively. CONCLUSION Isovolumetric 3D-THRIVE wrist MRA provided better results for depiction of intrinsic ligament and TFCC tears than wrist MRI.
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Affiliation(s)
- Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
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Smith TO, Drew B, Toms AP, Jerosch-Herold C, Chojnowski AJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. J Bone Joint Surg Am 2012; 94:824-32. [PMID: 22552672 DOI: 10.2106/jbjs.j.01775] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulnar-sided wrist pain and resultant functional disability. Diagnosis is based on the history and clinical examination as well as radiographic evidence of a TFCC central perforation or a radial/ulnar tear. The purpose of this study was therefore to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the detection of TFCC injury in the adult population. METHODS Published and unpublished literature databases were searched. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary receiver operating characteristic curve evaluations were performed. The methodological quality of each study was assessed with use of the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. RESULTS Twenty-one studies were included in the review, and these series included a total of 982 wrists. On meta-analysis, MRA was superior to MRI in the investigation of full-thickness TFCC tears, with a pooled sensitivity of 0.75 and a pooled specificity of 0.81 for MRI compared with 0.84 and 0.95, respectively, for MRA. MRA and MRI performed at greater field strengths were reported to have greater sensitivity and specificity than those performed at lower field strengths. There were insufficient data to assess the diagnostic test accuracy for partial-thickness TFCC tears. CONCLUSIONS Given its acceptable diagnostic test accuracy, it is recommended that MRA, rather than MRI, be performed in when there are questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain.
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Affiliation(s)
- Toby O Smith
- Faculty of Health, University of East Anglia, Norwich, United Kingdom.
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Assessment of Volar Radiocarpal Ligaments: MR Arthrographic and Arthroscopic Correlation. AJR Am J Roentgenol 2012; 198:423-7. [DOI: 10.2214/ajr.11.6919] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Stevens KJ, Wallace CG, Chen W, Rosenberg JK, Gold GE. Imaging of the wrist at 1.5 Tesla using isotropic three-dimensional fast spin echo cube. J Magn Reson Imaging 2011; 33:908-15. [PMID: 21448957 DOI: 10.1002/jmri.22494] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To compare three-dimensional fast spin echo Cube (3D-FSE-Cube) with conventional 2D-FSE in MR imaging of the wrist. MATERIALS AND METHODS The wrists of 10 volunteers were imaged in a 1.5 Tesla MRI scanner using an eight-channel wrist coil. The 3D-FSE-Cube images were acquired in the coronal plane with 0.5-mm isotropic resolution. The 2D-FSE images were acquired in both coronal and axial planes for comparison. An ROI was placed in fluid, cartilage, and muscle for SNR analysis. Comparable coronal and axial images were selected for each sequence, and paired images were randomized and graded for blurring, artifact, anatomic details, and overall image quality by three blinded musculoskeletal radiologists. RESULTS SNR of fluid, cartilage and muscle at prescribed locations were higher using 3D-FSE-Cube, without reaching statistical significance. Fluid-cartilage CNR was also higher with 3D-FSE-Cube, but not statistically significant. Blurring, artifact, anatomic details, and overall image quality were significantly better on coronal 3D-FSE-Cube images (P < 0.001), but significantly better on axial 2D-FSE images compared with axial 3D-FSE-Cube reformats (P < 0.01). CONCLUSION Isotropic data from 3D-FSE-Cube allows reformations in arbitrary scan planes, which may make multiple 2D acquisitions unnecessary, and improve depiction of complex wrist anatomy. However, axial reformations suffer from blurring, likely due to T2 decay during the long echo train, limiting overall image quality in this plane.
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Guntern D, Becce F, Richarme D, Palhais NS, Meuli R, Theumann N. Direct magnetic resonance arthrography of the wrist with axial traction: a feasibility study to assess joint cartilage. J Magn Reson Imaging 2011; 34:239-44. [PMID: 21618335 DOI: 10.1002/jmri.22615] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/15/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography of the wrist with regard to joint space width and amount of contrast material between the opposing cartilage surfaces. MATERIALS AND METHODS Fifteen consecutive patients (12 male, mean age 38.1 years) were included in this Institutional Review Board-approved prospective study. Three-compartment wrist MR arthrographies were performed between October and December 2009 on a 3 T unit using a fat-suppressed T1-weighted isotropic high-resolution volumetric interpolated breathhold examination (VIBE) sequence in the coronal plane, with and without axial traction (3 kg). Two radiologists measured radiocarpal (radioscaphoid, radiolunate) and midcarpal (lunocapitate, hamatolunate) joint space widths, with and without traction, and assessed the amount of contrast material between the opposing cartilage surfaces using a three-point scale: 0 = absence, 1 = partial, 2 = complete. RESULTS With traction, joint space width increased significantly at the radioscaphoid (Δ = 0.78 mm, P < 0.01), radiolunate (Δ = 0.18 mm, P < 0.01), and lunocapitate (Δ = 0.45 mm, P < 0.01) spaces, and both observers detected significantly more contrast material between the cartilage surfaces. At the hamatolunate space, the differences in joint space width (Δ = 0.14 mm, P = 0.54) and amount of contrast material were not significant. CONCLUSION Direct wrist MR arthrography with axial traction of 3 kg increases joint space width at the radiocarpal and lunocapitate spaces, and prompts better coverage of the articular cartilage by the contrast material.
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Affiliation(s)
- Daniel Guntern
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Shahabpour M, De Maeseneer M, Pouders C, Van Overstraeten L, Ceuterick P, Fierens Y, Goubau J, De Mey J. MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation. Eur J Radiol 2011; 77:196-201. [DOI: 10.1016/j.ejrad.2010.05.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/25/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE The aim of this article is to present the imaging patterns of ulnocarpal impaction syndrome (Palmer class II lesions) on MDCT arthrography. CONCLUSION MDCT arthrography is an excellent tool for imaging patients with clinically suspected ulnocarpal impaction syndrome, allowing identification of the spectrum of findings and proper classification according to Palmer class II (degenerative) lesions, which directly affects management.
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