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Crowe CS, Emanuels AF, Kakar S, Moran SL. Etiology and Diagnostic Challenges of Ulnar Wrist Pain in Pediatric and Adolescent Patients. J Hand Surg Am 2024:S0363-5023(24)00207-7. [PMID: 38934985 DOI: 10.1016/j.jhsa.2024.04.015] [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: 12/06/2023] [Revised: 04/06/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology. METHODS A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction. RESULTS A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n = 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n = 27, 68%) followed by UT split tears (n = 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury. CONCLUSION While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IIb.
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Affiliation(s)
- Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Andrew F Emanuels
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Sanjeev Kakar
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Mayo Clinic, Rochester, MN
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
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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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3
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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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Braig ZV, Dittman LE, Amrami KK, Kakar S. Dynamic Computed Tomography of the Distal Radioulnar Joint Versus Magnetic Resonance Imaging in Detecting Foveal Tears of the Triangular Fibrocartilage Complex. Hand (N Y) 2024:15589447241232012. [PMID: 38385200 DOI: 10.1177/15589447241232012] [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] [Indexed: 02/23/2024]
Abstract
BACKGROUND Diagnosis of foveal triangular fibrocartilage complex (TFCC) tears remains difficult. The purpose of this study was to evaluate whether dynamic computed tomography (CT) of the distal radioulnar joint (DRUJ) has a higher sensitivity in detecting foveal tears of the TFCC when compared with magnetic resonance imaging (MRI). METHODS A database query identified all patients above the age of 18 years with suspected foveal TFCC injuries who underwent bilateral dynamic CT imaging of the DRUJ, static 3T MRI, and subsequent wrist arthroscopy. All patients had evidence of foveal tenderness on clinical examination. The imaging results were validated with wrist arthroscopy. RESULTS Twelve patients with a mean age of 31 years (range, 18-53 years) were identified. Eight patients were diagnosed with a complete foveal detachment of the TFCC on wrist arthroscopy. Of the 8 patients with a foveal tear on DRUJ arthroscopy, only 3 had a preoperative physical examination suggestive of DRUJ instability. Magnetic resonance imaging identified foveal injuries in 4 of these 8 patients (sensitivity, 50%), and 3 of these were identified as only partial tears. Dynamic CT identified instability of DRUJ in 6 of 8 patients (sensitivity, 75%). Seven of 8 patients had imaging findings suggestive of a foveal tear when including either MRI or CT imaging (sensitivity, 88%). Of the 4 patients with an intact foveal attachment on arthroscopy, 3 (specificity, 75%) had a stable DRUJ on CT and all 4 (specificity, 100%) had an intact foveal attachment on MRI. CONCLUSION Sixty-two percent of patients with foveal tears on arthroscopy have a stable DRUJ on clinical examination. When combining MRI and dynamic CT imaging of the DRUJ, the sensitivity of detecting a foveal TFCC tear approaches 88% compared with a gold standard of wrist arthroscopy.
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Affiliation(s)
- Zachary V Braig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lauren E Dittman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Pogarell T, Heiss R, Janka R, Nagel AM, Uder M, Roemer FW. Modern low-field MRI. Skeletal Radiol 2024:10.1007/s00256-024-04597-4. [PMID: 38381197 DOI: 10.1007/s00256-024-04597-4] [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: 12/04/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
This narrative review explores recent advancements and applications of modern low-field (≤ 1 Tesla) magnetic resonance imaging (MRI) in musculoskeletal radiology. Historically, high-field MRI systems (1.5 T and 3 T) have been the standard in clinical practice due to superior image resolution and signal-to-noise ratio. However, recent technological advancements in low-field MRI offer promising avenues for musculoskeletal imaging. General principles of low-field MRI systems are being introduced, highlighting their strengths and limitations compared to high-field counterparts. Emphasis is placed on advancements in hardware design, including novel magnet configurations, gradient systems, and radiofrequency coils, which have improved image quality and reduced susceptibility artifacts particularly in musculoskeletal imaging. Different clinical applications of modern low-field MRI in musculoskeletal radiology are being discussed. The diagnostic performance of low-field MRI in diagnosing various musculoskeletal pathologies, such as ligament and tendon injuries, osteoarthritis, and cartilage lesions, is being presented. Moreover, the discussion encompasses the cost-effectiveness and accessibility of low-field MRI systems, making them viable options for imaging centers with limited resources or specific patient populations. From a scientific standpoint, the amount of available data regarding musculoskeletal imaging at low-field strengths is limited and often several decades old. This review will give an insight to the existing literature and summarize our own experiences with a modern low-field MRI system over the last 3 years. In conclusion, the narrative review highlights the potential clinical utility, challenges, and future directions of modern low-field MRI, offering valuable insights for radiologists and healthcare professionals seeking to leverage these advancements in their practice.
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Affiliation(s)
- Tobias Pogarell
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany.
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Armin M Nagel
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
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6
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Heiss R, Höger SA, Uder M, Hotfiel T, Hanspach J, Laun FB, Nagel AM, Roemer FW. Early functional and morphological changes of calf muscles in delayed onset muscle soreness (DOMS) assessed with 7T MRI. Ann Anat 2024; 251:152181. [PMID: 37871829 DOI: 10.1016/j.aanat.2023.152181] [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: 07/16/2023] [Revised: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND To assess morphological and functional alterations of the skeletal muscle in exercise-induced delayed onset muscle soreness (DOMS) using 7 Tesla (T) magnetic resonance imaging (MRI). METHODS DOMS was induced in 16 volunteers performing an eccentric exercise protocol of the calf muscles of one randomized leg. 7 T MRI including T1w- (0.18×0.18×1mm3), T2w-images (0.2×0.2×2mm3), T2-maps (0.5×0.5×5mm3), and susceptibility weighted imaging (SWI, 0.7×0.7×0.7 mm3) were acquired at baseline, directly (t1) and 60 hours (t2) after the exercise. T2 signal intensity (SI), T2 values [ms], T1 SI and SWI were assessed in the medial (MG) and lateral gastrocnemius muscle (LG) and in the soleus muscle (SM). In addition, the serum creatine kinase (CK) activity, range of motion (ROM) of the ankle, calf circumference, and muscle soreness were assessed at each time point. RESULTS Directly after exercise (t1), T2 SI (p=0.04) and T2 values (p=0.03) increased significantly in the LG. No changes of SI and T2 values for MG and SM were present at t1. At t2, T2 SI and T2 values of LG (p=0.001, p=0.02) and MG (p=0.04, p=0.03) increased significantly compared to baseline. T1 SI did not change in any muscle at any time point. In SWI, no signs of intramuscular signal drop could be detected. Clinical parameters confirmed the induction of DOMS, with a significant increase of CK (p=0.03), muscle soreness (p<0.001), calf circumference (p=0.001), and respective a decrease of ROM (p=0.04). CONCLUSIONS 7 T MRI has the potential to visualize microstructural muscle damage immediately after an exercise that induces DOMS. No changes in susceptibility which could, for example, reflect micro-hemorrhage, could be detected with SWI immediately after exercise or in DOMS. Ultra-high field MRI may potentially be used in sports medicine to monitor intramuscular structural changes, allowing for modification of training intensity or to implement appropriate therapeutic strategies.
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Affiliation(s)
- Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany.
| | - Svenja A Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Krankenhausstr. 12, Erlangen 91054, Germany; Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück GmbH, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück 49076, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frank W Roemer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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Miyasaka T, Kajiwara M, Kawasaki A, Okamoto Y, Terada Y. Development of a Car-mounted Mobile MR Imaging System for Diagnosis of Sports-related Wrist Injury. Magn Reson Med Sci 2023; 22:379-387. [PMID: 35473757 PMCID: PMC10449548 DOI: 10.2463/mrms.tn.2021-0158] [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: 12/08/2021] [Accepted: 03/12/2022] [Indexed: 11/09/2022] Open
Abstract
Portable MRI scanners, in which a permanent magnet with a low magnetic field is mounted on a small car, have enabled the performance of MRI examinations in various remote environments. Here, we have modified the portable MRI system to enable the early diagnosis of wrist sports injuries among tennis players. A RF probe specifically designed for the human wrist was developed, and a power supply scheme using a small generator was introduced. The portable MRI system was located at a tennis school and imaging of the wrists of junior tennis players was performed. To demonstrate clinical feasibility, image quality was assessed by a radiologist and clinical evaluations were performed. In most cases, the image quality was sufficient for diagnosis, and triangular fibrocartilage complex damage could be detected. The results indicated that the modified portable MRI system could be applied for an early diagnosis of wrist injuries.
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Affiliation(s)
- Tomoki Miyasaka
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Michiru Kajiwara
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akito Kawasaki
- Graduate School of Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshikazu Okamoto
- Institute of Clinical Medicine, Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuhiko Terada
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Heiss R, Weber MA, Balbach E, Schmitt R, Rehnitz C, Laqmani A, Sternberg A, Ellermann JJ, Nagel AM, Ladd ME, Englbrecht M, Arkudas A, Horch R, Guermazi A, Uder M, Roemer FW. Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study. Radiology 2023; 307:e220753. [PMID: 36625744 DOI: 10.1148/radiol.220753] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]-weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20-0.64). Conclusion A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Marc-André Weber
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Eva Balbach
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Rainer Schmitt
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Christoph Rehnitz
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Azien Laqmani
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Andreas Sternberg
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Jutta J Ellermann
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Armin M Nagel
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Mark E Ladd
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Matthias Englbrecht
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Andreas Arkudas
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Raymund Horch
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Ali Guermazi
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Michael Uder
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Frank W Roemer
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
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10
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Crowe CS, Kakar S. Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries : an under-recognized spectrum of injury. Bone Joint J 2023; 105-B:5-10. [PMID: 36587253 DOI: 10.1302/0301-620x.105b1.bjj-2022-0908.r1] [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] [Indexed: 01/02/2023]
Abstract
Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.Cite this article: Bone Joint J 2023;105-B(1):5-10.
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Affiliation(s)
| | - Sanj Kakar
- Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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12
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Morway GR, Miller A. Clinical and Radiographic Evaluation of Ulnar-Sided Wrist Pain. Curr Rev Musculoskelet Med 2022; 15:590-596. [PMID: 36173549 PMCID: PMC9789218 DOI: 10.1007/s12178-022-09790-3] [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] [Accepted: 08/31/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Ulnar-sided wrist pain is a challenging diagnostic workup. A thorough and complete physical examination followed by appropriate radiographic studies can help the clinician diagnose and treat these conditions. RECENT FINDINGS Recent research has been focused on diagnostic modalities such as arthroscopy and high-resolution MRI. Ulnar-sided wrist pain is a challenging clinical workup that must be approached systematically with the aid of adjunctive diagnostic modalities.
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Affiliation(s)
| | - Andrew Miller
- Philadelphia Hand to Shoulder Center at Thomas Jefferson University Hospital, 834 Chestnut St G114, Philadelphia, PA USA
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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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Editorial Commentary: Artificial Intelligence for the Wrist: Moving to the Forefront of Diagnostic Imaging for Triangular Fibrocartilage Complex Injury. Arthroscopy 2022; 38:2425-2426. [PMID: 35940740 DOI: 10.1016/j.arthro.2022.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
Accurate diagnosis of the etiology of ulnar-sided wrist pain and injury to the triangular fibrocartilage complex, particularly Palmar 1B tears, can prove to be challenging. Multiple peer-reviewed studies have demonstrated that accurate diagnosis and treatment of tears of the triangular fibrocartilage complex through nonoperative and operative means, including arthroscopy, can result in improved patient outcomes and function. One of the keys to successful treatment, however, is accurate diagnosis. While our current imaging modalities help to provide additional data for the assessment of this pathology, magnetic resonance imaging and computed tomography scans have limitations. Thus, employing the power of artificial intelligence and deep learning to ultrasound assessment of this injury is appealing. Efficient integration of this technology into daily practice has potential to bolster diagnostics not only in large medical centers but also in underserved areas with limited access to magnetic resonance imaging and computed tomography.
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Brui E, Mikhailovskaya A, Solomakha G, Efimtcev A, Andreychenko A, Shchelokova A. Volumetric wireless coil for wrist MRI at 1.5 T as a practical alternative to Tx/Rx extremity coil: a comparative study. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2022; 339:107209. [PMID: 35397309 DOI: 10.1016/j.jmr.2022.107209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
This work performs a detailed assessment of radiofrequency (RF) safety and imaging performance of a volumetric wireless coil based on periodically coupled split-loop resonators (SLRs) for 1.5 T wrist MRI versus a commercially available transceive extremity coil. In particular, we evaluated the transmit efficiency and RF safety for three setups: a whole-body birdcage coil, a transceive extremity birdcage coil, and a volumetric wireless coil inductively coupled to the whole-body birdcage coil. The imaging performance of the two latter setups was studied experimentally for nine subjects. The signal-to-noise ratio (SNR) of the images acquired with several standard pulse sequences for osteoarthritis wrist imaging was assessed. Application of the wireless coil significantly improved the specific absorption rate (SAR) efficiency of the whole-body birdcage coil, with at least 4.3-fold and 7.6-fold improvement of local and global SAR efficiencies, respectively. This setup also outperformed the transceive extremity coil in terms of SNR (up to 1.40-fold gain) with a moderate (11%) reduction of the local SAR efficiency.
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Affiliation(s)
- Ekaterina Brui
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Anna Mikhailovskaya
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia; School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Georgiy Solomakha
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Alexander Efimtcev
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia; Department of Radiology, Federal Almazov North-West Medical Research Center, St. Petersburg, Russia
| | - Anna Andreychenko
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia; Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Alena Shchelokova
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia.
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16
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Lee GE, Forster GL, Freilich AM, DeGeorge BR. Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries. J Wrist Surg 2022; 11:120-126. [PMID: 35478944 PMCID: PMC9038300 DOI: 10.1055/s-0041-1735305] [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: 05/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Background There is no consensus on the utility of arthrography in the evaluation of wrist injuries. This study evaluates ordering trends of different types of magnetic resonance imaging (MRI) of the wrist and compares rates of surgery following these imaging modalities. Methods A national claims-based database was used to identify patients who underwent MRI within 90 days of a first-instance diagnosis of wrist injury from 2010 to 2018. The utilization of MRI without intravenous (IV) contrast, MRI with IV contrast, and MRI with arthrogram was investigated. The instances of operative procedures of the wrist within 1 year of MRI study were recorded. Patient demographics, comorbidities, type of operative procedure, and ordering physician specialty were obtained. Logistic regression analysis was used to evaluate the utilization of MRI and subsequent 1-year operative intervention rates as well as association of patient-related factors. Results Magnetic resonance arthrography use was associated with higher rates of subsequent operative treatment. Surgeons were more likely to order an arthrogram at the time of MRI. Younger patients were more likely to undergo MRI-based advanced imaging. Conclusion Surgeons may perceive MRA of the wrist to play an important role in operative decision-making following wrist injury. Level of Evidence This is a Level III, retrospective cohort study.
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Affiliation(s)
- Glenn E. Lee
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Grace L. Forster
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Aaron M. Freilich
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brent R. DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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17
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De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex. J Wrist Surg 2022; 11:28-34. [PMID: 35127261 PMCID: PMC8807093 DOI: 10.1055/s-0041-1729757] [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: 11/29/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis. Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection. Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I-III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings. Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases. Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage. Level of Evidence This is a Level II, retrospective comparative study.
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Affiliation(s)
| | | | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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18
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Kreulen RT, Nayar SK, Alfaki Y, LaPorte D, Demehri S. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37:477-486. [PMID: 34602127 DOI: 10.1016/j.hcl.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.
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Affiliation(s)
- R Timothy Kreulen
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA.
| | - Suresh K Nayar
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Yasmin Alfaki
- Johns Hopkins University, 3400 North Charles Street, Mason Hall, Baltimore, MD 21218, USA
| | - Dawn LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Shadpour Demehri
- Johns Hopkins Department of Musculoskeletal Radiology, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
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19
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Abstract
Instability of the distal radioulnar joint is a source of ulnar-sided wrist pain and functional impairment. Symptomatic instability may present acutely, after a recent traumatic injury, or in a delayed fashion as chronic instability following a history of a traumatic event. A detailed understanding of the complex anatomy, biomechanics, and stabilizing structures of the distal radioulnar joint is important to evaluate and treat acute and chronic instability. This article describes the pathophysiology of distal radioulnar joint instability with attention to the anatomic structures involved and provides information about evaluation and treatment.
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Affiliation(s)
- Brandon Boyd
- Hand and Upper Extremity Fellow, Philadelphia Hand to Shoulder Center, 834 Chestnut Street, G114, Philadelphia, PA 19107, USA
| | - Julie Adams
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine- Chattanooga, 960 East Third Street, Suite 100, Chattanooga, TN 37403, USA.
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20
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Schick F, Pieper CC, Kupczyk P, Almansour H, Keller G, Springer F, Mürtz P, Endler C, Sprinkart AM, Kaufmann S, Herrmann J, Attenberger UI. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 1. Invest Radiol 2021; 56:680-691. [PMID: 34324464 DOI: 10.1097/rli.0000000000000812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Whole-body magnetic resonance imaging (MRI) systems with a field strength of 3 T have been offered by all leading manufacturers for approximately 2 decades and are increasingly used in clinical diagnostics despite higher costs. Technologically, MRI systems operating at 3 T have reached a high standard in recent years, as well as the 1.5-T devices that have been in use for a longer time. For modern MRI systems with 3 T, more complexity is required, especially for the magnet and the radiofrequency (RF) system (with multichannel transmission). Many clinical applications benefit greatly from the higher field strength due to the higher signal yield (eg, imaging of the brain or extremities), but there are also applications where the disadvantages of 3 T might outweigh the advantages (eg, lung imaging or examinations in the presence of implants). This review describes some technical features of modern 1.5-T and 3-T whole-body MRI systems, and reports on the experience of using both types of devices in different clinical settings, with all sections written by specialist radiologists in the respective fields.This first part of the review includes an overview of the general physicotechnical aspects of both field strengths and elaborates the special conditions of diffusion imaging. Many relevant aspects in the application areas of musculoskeletal imaging, abdominal imaging, and prostate diagnostics are discussed.
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Affiliation(s)
- Fritz Schick
- From the Section of Experimental Radiology, Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Patrick Kupczyk
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Haidara Almansour
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Gabriel Keller
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Fabian Springer
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Petra Mürtz
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Christoph Endler
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alois M Sprinkart
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Sascha Kaufmann
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Judith Herrmann
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Ulrike I Attenberger
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
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21
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Abstract
Triangular fibrocartilage complex (TFCC) tears can cause ulnar-sided wrist pain in children and adolescents following acute rotational injury or prior distal radius fracture. Surgical treatment, guided by the Palmer classification, is considered after activity modification and occupational therapy. All concomitant wrist pathologies, such as distal radioulnar joint instability, ulnocarpal impaction, and distal radius malunion, must be recognized and addressed at the time of TFCC debridement or repair. This article reviews recent literature guiding clinical evaluation and surgical treatment of children and adolescents with TFCC injuries. The authors' techniques for arthroscopic-assisted outside-in repair of Palmer 1B and 1D tears are described.
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Affiliation(s)
- Stella J Lee
- Department of Surgery, Anna Jaques Hospital, 25 Highland Avenue, Newburyport, MA 01950, USA.
| | - Donald S Bae
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan 2nd Floor, Boston, MA 02115, USA
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22
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Khodarahmi I, Fritz J. The Value of 3 Tesla Field Strength for Musculoskeletal Magnetic Resonance Imaging. Invest Radiol 2021; 56:749-763. [PMID: 34190717 DOI: 10.1097/rli.0000000000000801] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Musculoskeletal magnetic resonance imaging (MRI) is a careful negotiation between spatial, temporal, and contrast resolution, which builds the foundation for diagnostic performance and value. Many aspects of musculoskeletal MRI can improve the image quality and increase the acquisition speed; however, 3.0-T field strength has the highest impact within the current diagnostic range. In addition to the favorable attributes of 3.0-T field strength translating into high temporal, spatial, and contrast resolution, many 3.0-T MRI systems yield additional gains through high-performance gradients systems and radiofrequency pulse transmission technology, advanced multichannel receiver technology, and high-end surface coils. Compared with 1.5 T, 3.0-T MRI systems yield approximately 2-fold higher signal-to-noise ratios, enabling 4 times faster data acquisition or double the matrix size. Clinically, 3.0-T field strength translates into markedly higher scan efficiency, better image quality, more accurate visualization of small anatomic structures and abnormalities, and the ability to offer high-end applications, such as quantitative MRI and magnetic resonance neurography. Challenges of 3.0-T MRI include higher magnetic susceptibility, chemical shift, dielectric effects, and higher radiofrequency energy deposition, which can be managed successfully. The higher total cost of ownership of 3.0-T MRI systems can be offset by shorter musculoskeletal MRI examinations, higher-quality examinations, and utilization of advanced MRI techniques, which then can achieve higher gains and value than lower field systems. We provide a practice-focused review of the value of 3.0-T field strength for musculoskeletal MRI, practical solutions to challenges, and illustrations of a wide spectrum of gainful clinical applications.
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Affiliation(s)
- Iman Khodarahmi
- From the Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, NY
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23
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Götestrand S, Björkman A, Björkman-Burtscher IM, Kristiansson I, Aksyuk E, Szaro P, Markenroth Bloch K, Geijer M. Visualization of wrist anatomy-a comparison between 7T and 3T MRI. Eur Radiol 2021; 32:1362-1370. [PMID: 34378077 PMCID: PMC8795032 DOI: 10.1007/s00330-021-08165-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Injuries to the wrist are, due to its small size and complex anatomical structures, difficult to assess by MR, and surgical interventions such as diagnostic arthroscopy are often necessary. Therefore, improved visualization using non-invasive methods could be of clinical value. As a first step of improvement, the purpose of this study was to evaluate visualization of anatomical structures at 7T compared with 3T MR. METHODS Eighteen healthy volunteers (three males and three females from each age decade between 20 and 49 years) were examined with 7T and 3T MR. Four musculoskeletal radiologists graded 2D and 3D images on a five-level grading scale for visibility of ligaments, cartilage, nerves, trabecular bone, and tendons, as well as overall image quality (i.e., edge sharpness, perceived tissue contrast, and presence of artefacts). Statistical analysis was done using a visual grading characteristics (VGC) analysis. RESULTS Visibility of cartilage, trabecular bone, tendons, nerves, and ligaments was graded significantly higher at 7T with an area under the curve (AUCVGC) of 0.62-0.88 (95% confidence interval [CI] 0.50-0.97, p = < 0.0001-0.03) using either 2D or 3D imaging. Imaging with 3T was not graded as superior to 7T for any structure. Image quality was also significantly superior at 7T, except for artefacts, where no significant differences were found. CONCLUSIONS Tendons, trabecular bone, nerves, and ligaments were all significantly better visualized at 7T compared to 3T. KEY POINTS • MRI of the wrist at 7T with a commercially available wrist coil is feasible at similar acquisition times as for 3T MRI. • The current study showed 7T to be superior to 3T in the visualization of anatomical structures of the wrist, including ligaments, tendons, nerves, and trabecular bone. • Image quality was significantly superior at 7T, except for artefacts, where no significant differences were found.
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Affiliation(s)
- Simon Götestrand
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden. .,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ingvar Kristiansson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Elenya Aksyuk
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mats Geijer
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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24
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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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25
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Shin YE, Kim SJ, Kim JS, Kwak KY, Kim JH, Kim JP. Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy. J Orthop Surg (Hong Kong) 2021; 28:2309499020978308. [PMID: 33345693 DOI: 10.1177/2309499020978308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. METHODS A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared. RESULTS Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). CONCLUSION Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.
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Affiliation(s)
- Yong-Eun Shin
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Sung-Joon Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Jeong-Sang Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Kwon-Young Kwak
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Ji-Hyo Kim
- Department of Teaching Education, College of Liberal Arts, Dankook University, Cheonan, Republic of Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
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26
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Abstract
Background: Magnetic resonance imaging (MRI) is frequently used in the diagnosis of upper extremity conditions. We hypothesize that the results often do not change treatment. The purpose of the present study was to prospectively assess the extent to which MRI findings alter patient management. Methods: Ten hand surgeons who were ordering an MRI (elbow or distal) completed a standardized questionnaire. Prior to obtaining the MRI, the surgeon recorded their pre-MRI diagnosis and recommended treatment if no MRI could be obtained. Following the MRI, the surgeon recorded their post-MRI diagnosis and ultimate treatment recommendation. Finally, the surgeon answered whether the MRI was helpful, and if so, how it helped guide their treatment. Descriptive statistics were performed. Results: One hundred eighty-seven MRIs were ordered. The most common reasons for ordering an MRI were the evaluation of presumed occult scaphoid fracture, ulnar wrist pain, metacarpophalangeal joint collateral ligament injury, and mass. The surgeon agreed with the radiologist's interpretation of the MRI in 88% of cases. Overall, surgeons found the MRI to be helpful in 92% of cases, and the recommended treatment changed as a result of the MRI findings in 19% (35/187) of patients. Of these 35 patients, 9 had a pre-MRI diagnosis that was concordant with the MRI findings, but the proposed management of the patient changed after the MRI. Conclusions: Hand surgeons infrequently change their treatment plan based on MRI findings. Given the importance of cost-efficient care, indications for use of MRI may need to be re-evaluated.
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Affiliation(s)
- Michael J. DeFrance
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA,Michael J. DeFrance, Rowan University School of Osteopathic Medicine, 1 Medical Center Drive, Stratford, NJ 08084, USA.
| | - Kevin F. Lutsky
- Rothman Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonas L. Matzon
- Rothman Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
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27
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Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features-preliminary findings. Skeletal Radiol 2021; 50:531-541. [PMID: 32845377 PMCID: PMC7811987 DOI: 10.1007/s00256-020-03588-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation. MATERIALS AND METHODS Seventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials' (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA. RESULTS PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score "periarticular inflammation"), with low odds for the presence of RA (OR of 0.06, p < 0.01) at all metacarpophalangeal (MCP) joints. A prediction model informed by the items that were strongest associated with the presence of RA or PsA demonstrated excellent differentiating capability with an area under the curve of 98.1%. CONCLUSION High-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA.
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28
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van der Post AS, Jens S, Smithuis FF, Obdeijn MC, Oostra RJ, Maas M. The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology. Skeletal Radiol 2021; 50:2195-2204. [PMID: 33864484 PMCID: PMC8449761 DOI: 10.1007/s00256-021-03779-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. MATERIALS AND METHODS Prospectively collected data on asymptomatic participants aged 12-18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss' kappa with 95% confidence intervals (95% CI). RESULTS The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0-17.0). Median ulnar variance was -0.7 mm (range - 2.7-1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1-2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. CONCLUSION MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.
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Affiliation(s)
- Anne-Sophie van der Post
- grid.7177.60000000084992262Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, The Netherlands
| | - Sjoerd Jens
- grid.415930.aDepartment of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank F. Smithuis
- grid.7177.60000000084992262Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Miryam C. Obdeijn
- grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- grid.7177.60000000084992262Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mario Maas
- grid.7177.60000000084992262Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, The Netherlands
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Kader N, Arshad MS, Chajed PK, Makki D, Naikoti K, Temperley D, Murali SR. Evaluating Accuracy of Plain Magnetic Resonance Imaging or Arthrogram versus Wrist Arthroscopy in the Diagnosis of Scapholunate Interosseous Ligament Injury. J Hand Microsurg 2020; 14:298-303. [DOI: 10.1055/s-0040-1719231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractIntroduction Scapholunate interosseous ligament injury (SLIL) is the most common cause of wrist instability and a cause of morbidity in a proportion of patients with wrist injuries.Aim To evaluate the accuracy of plain magnetic resonance imaging (MRI) and MR arthrogram (MRA) in the diagnosis of SLIL injury against the existing gold standard-wrist arthroscopy.Materials and Methods We retrospectively reviewed 108 cases by comparing MRI/MRA reports and their wrist arthroscopy operation notes.Results Overall MRI sensitivity to SLIL injuries was 38.5% (91.0% specificity). When broken down into plain MRI and MRA the results were: plain MRI sensitivity = 19.2% (91.4% specificity) and MRA sensitivity = 57.7% (90.5% specificity).Conclusion Neither MRI nor MRA scanning is sensitive enough compared with the gold standard. Positive predictive value remains too low (62.5 and 88.2%, respectively) to consider bypassing diagnostic arthroscopy and treating surgically. The negative predictive value (60.4 and 63.6%, respectively) is inadequate to confirm exclusion of injury from MRI results alone.
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Affiliation(s)
- Nardeen Kader
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
| | | | - Pawan K. Chajed
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
| | - Daoud Makki
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
| | - Kiran Naikoti
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
| | - David Temperley
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
| | - S. Raj Murali
- Upper Limb Unit, Trauma and Orthopaedics, Wrightington Hospital, Wigan, United Kingdom
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Krastman P, Mathijssen NMC, Bierma-Zeinstra SMA, Kraan GA, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update. BMJ Open 2020; 10:e037810. [PMID: 33154046 PMCID: PMC7646346 DOI: 10.1136/bmjopen-2020-037810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist. METHODS Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted. RESULTS None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively. CONCLUSIONS There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Abstract
Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.
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Affiliation(s)
- David M Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard A Berger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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A Novel Arthroscopic-assisted Repair of Palmer 1B Triangular Fibrocartilage Complex Tears: Early Results. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gire JD, Yao J. Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clin Sports Med 2020; 39:313-337. [PMID: 32115087 DOI: 10.1016/j.csm.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.
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Affiliation(s)
- Jacob D Gire
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA.
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Abstract
Imaging plays a key role in the evaluation and treatment planning of hand and wrist injuries in athletes. Depending on the suspected injury, a combination of conventional radiographs, computed tomography, magnetic resonance imaging, magnetic resonance arthrography, and/or ultrasound may be indicated. This article reviews the strengths and limitations of these imaging modalities and how they can be utilized in commonly encountered clinical questions.
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Affiliation(s)
| | - B Matthew Howe
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Petsatodis E, Pilavaki M, Kalogera A, Drevelegas A, Agathangelidis F, Ditsios K. Comparison between conventional MRI and MR arthrography in the diagnosis of triangular fibrocartilage tears and correlation with arthroscopic findings. Injury 2019; 50:1464-1469. [PMID: 31387739 DOI: 10.1016/j.injury.2019.07.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The triangular fibrocartilage complex is one of the most important stabilizers of the wrist and a defect in its anatomical structure is a possible cause of ulnar sided wrist pain. The aim of this study is to compare the diagnostic accuracy between conventional MRI and MR arthrography (MRA) in the depiction of triangular fibrocartilage complex (TFCC) tears. METHODS-MATERIALS A total of 60 patients with clinical findings that suggested TFCC tears underwent wrist MRI and MRA. All the MRI and MRA results were compared with the arthroscopic findings. RESULTS 40 tears were confirmed by arthroscopy. 38/40 tears were identified by MRA while MRI identified 26/40 tears. There were also 8 false positives and 13 false negative results identified by MRI. Two false negative results were identified by MRA. No false positive results were identified. CONCLUSION MR arthrography is more sensitive and specific method in terms of the diagnosis of TFCC tears compared to conventional wrist MRI. There was no difference in the diagnostic accuracy between wrist arthroscopy and MRA.
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Affiliation(s)
| | - Mayia Pilavaki
- Radiology Department, General Hospital G. Papanikolaou, Thessaloniki, Greece
| | - Anna Kalogera
- Radiology Department, Aristotle University, Thessaloniki, Greece
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Tang CQY, Lai SWH, Leow G, Tay SC. Patient-Reported Outcome Following Ulnotriquetral Ligament Split Tear Repair. J Hand Surg Asian Pac Vol 2019; 22:445-451. [PMID: 29117822 DOI: 10.1142/s0218810417500484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND While the clinical presentation and mechanism of injury of ulnotriquetral (UT) ligament split tear had been well described, there has been no other studies that has reported on the outcome of a UT ligament repair. This study aims to look at the patient-reported outcomes following UT ligament split tear repair. METHODS 18 wrists (13 right and 5 left) in 17 patients (12 males and 5 females, mean age 25.0 ± 8.4 years, range 16-50 years) who had UT ligament split tear and undergone surgical repair between November 2007 and December 2013 were retrospectively analysed. Patient-reported outcome of resolution of pain, and objective measurements such as improvement in grip strength and range of movement of the wrist were recorded. Patients were followed up until the pain was completely resolved or the last documented consultation. The mean follow-up duration was 16.2 months. RESULTS 94% reported improvements post-surgery, of which 63% reported complete resolution of pain. 6% reported no improvement in pain post-operatively. No patient reported worsening of pain after the surgery. There was significant improvement in grip strength from a mean of 23.5 kg to 27.1 kg. There was no significant change in range of motion of the wrist. CONCLUSIONS The majority of patients reported resolution or improvement of pain after surgical repair. In addition, there was statistically significant improvement in grip strength recorded.
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Affiliation(s)
| | - Sean Wei Hong Lai
- * Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Geraldine Leow
- † Duke-National University of Singapore Graduate Medical School, Singapore
| | - Shian Chao Tay
- † Duke-National University of Singapore Graduate Medical School, Singapore.,‡ Department of Hand Surgery, Singapore General Hospital, Singapore
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Robba VI, Karantana A, Fowler APG, Diver C. Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study. J Hand Surg Eur Vol 2019; 44:572-581. [PMID: 30741080 DOI: 10.1177/1753193419826459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons' experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons (n = 10) was recruited through 'snow-balling' until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V.
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Affiliation(s)
- Vanessa I Robba
- 1 Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Alexia Karantana
- 2 Centre for Evidence-Based Hand Surgery, University of Nottingham, Nottingham, UK
| | | | - Claire Diver
- 4 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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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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Thomsen NOB, Besjakov J, Björkman A. Accuracy of Pre- and Postcontrast, 3 T Indirect MR Arthrography Compared with Wrist Arthroscopy in the Diagnosis of Wrist Ligament Injuries. J Wrist Surg 2018; 7:382-388. [PMID: 30349750 PMCID: PMC6196091 DOI: 10.1055/s-0038-1661419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/21/2018] [Indexed: 01/05/2023]
Abstract
Background Magnetic resonance (MR) is the most important imaging technique to assess intra-articular pathology of the wrist. Among various MR imaging protocols, the diagnostic performance of indirect MR arthrography needs further investigation. Purpose The purpose of this study was to assess the diagnostic performance of pre- and postcontrast, 3 T indirect MR arthrography in the diagnosis of scapholunate intrinsic ligament (SLIL) and triangular fibrocartilage complex (TFCC) injuries, using wrist arthroscopy as reference standard. Patients and Methods We retrospectively evaluated consecutive patients with suspected SLIL or TFCC injury, who had indirect MR arthrography done before arthroscopy. Images were assessed independently by two senior radiologists. Results Arthroscopy of the 53 wrists demonstrated 16 Geissler stages II and III partial tears and 6 stage IV total SLIL ruptures. Central perforation of the TFCC was found in 24 wrists, and 12 wrists had an ulnar class 1B lesion. To detect any SLIL tear, accuracy was higher for the two observers using postcontrast indirect MR arthrography (0.77 and 0.72) than for precontrast MR imaging (0.60 and 0.60). No difference was found for total SLIL ruptures "0.85 and 0.89" versus "0.85 and 0.89." To diagnose class 1B TFCC injuries, accuracy was higher using postcontrast indirect MR arthrography (0.85 and 0.75) than for precontrast MR imaging (0.70 and 0.72). No difference in accuracy was demonstrated for TFCC central tears "0.75 and 0.75" versus "0.70 and 0.77." Conclusion Postcontrast images at 3 T indirect MR arthrography, compared with precontrast images, have an improved diagnostic performance for the overall detection of SLIL injuries and as well as class 1B TFCC tears. Level of Evidence This is a Level II, diagnostic study.
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Affiliation(s)
- N. O. B. Thomsen
- Department of Clinical Sciences Malmö –Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - J. Besjakov
- Department of Radiology, Skåne University Hospital, Malmö, Sweden
| | - A. Björkman
- Department of Clinical Sciences Malmö –Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
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Bendre HH, Oflazoglu K, van Leeuwen WF, Rakhorst H, Ring D, Chen NC. The Prevalence of Triangular Fibrocartilage Complex Signal Abnormalities on Magnetic Resonance Imaging Relative to Clinical Suspicion of Pathology. J Hand Surg Am 2018; 43:819-826.e1. [PMID: 30172277 DOI: 10.1016/j.jhsa.2018.06.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/12/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prevalence of triangular fibrocartilage complex (TFCC) signal changes in patients undergoing magnetic resonance imaging (MRI) of the wrist and its relationship to a clinical suspicion of TFCC pathology. The secondary purpose was to study factors that are associated with TFCC signal changes. METHODS In this retrospective study, we looked for any TFCC signal changes in the reports of MRI findings performed during a 3-year period in 1,134 patients. Demographic characteristics, the categorized indications for MRI, and symptoms at the time of the MRI were also retrieved from the medical records. Patients were divided into 6 groups, based on age, to calculate the proportions of TFCC signal changes in the entire cohort and as an incidental finding among patients without a clinical suspicion of TFCC pathology within each age group. RESULTS A total of 321 patients (28%) had incidental TFCC signal changes. The prevalence among 18- to 30 year-olds was 19%, and increased to 64% in patients older than 70 years. Multivariable logistic regression analysis demonstrated that an increase in age is significantly associated with having TFCC signal changes on MRI in patients who have a low clinical suspicion of TFCC pathology. The rate of incidental TFCC signal changes steadily increases with age. CONCLUSIONS The TFCC signal abnormalities on MRI are more common with increasing age in patients with low clinical suspicion of TFCC pathology. At age 70, more than half of all patients will have TFCC signal changes, and more than 90% are present in patients with a low clinical suspicion of TFCC pathology. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Hersh H Bendre
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kamilcan Oflazoglu
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Wouter F van Leeuwen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hinne Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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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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43
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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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44
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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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Discussion: Appropriateness of the Use of Magnetic Resonance Imaging in the Diagnosis and Treatment of Wrist Soft Tissue Injury. Plast Reconstr Surg 2018; 141:420-421. [PMID: 29369993 DOI: 10.1097/prs.0000000000004087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhan H, Zhang H, Bai R, Qian Z, Liu Y, Zhang H, Yin Y. High-resolution 3-T MRI of the triangular fibrocartilage complex in the wrist: injury pattern and MR features. Skeletal Radiol 2017; 46:1695-1706. [PMID: 28808764 DOI: 10.1007/s00256-017-2739-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate if using high-resolution 3-T MRI can identify additional injuries of the triangular fibrocartilage complex (TFCC) beyond the Palmer classification. MATERIALS AND METHODS Eighty-six patients with surgically proven TFCC injury were included in this study. All patients underwent high-resolution 3-T MRI of the injured wrist. The MR imaging features of TFCC were analyzed according to the Palmer classification. RESULTS According to the Palmer classification, 69 patients could be classified as having Palmer injuries (52 had traumatic tears and 17 had degenerative tears). There were 17 patients whose injuries could not be classified according to the Palmer classification: 13 had volar or dorsal capsular TFC detachment and 4 had a horizontal tear of the articular disk. CONCLUSION Using high-resolution 3-T MRI, we have not only found all the TFCC injuries described in the Palmer classification, additional injury types were found in this study, including horizontal tear of the TFC and capsular TFC detachment. We propose the modified Palmer classification and add the injury types that were not included in the original Palmer classification.
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Affiliation(s)
- Huili Zhan
- Department of Radiology, Peking University Fourth School of Clinical Medicine, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Huibo Zhang
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Rongjie Bai
- Department of Radiology, Peking University Fourth School of Clinical Medicine, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China. .,Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Zhanhua Qian
- Department of Radiology, Peking University Fourth School of Clinical Medicine, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.,Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yue Liu
- Department of Radiology, Peking University Fourth School of Clinical Medicine, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Heng Zhang
- Department of Radiology, Peking University Fourth School of Clinical Medicine, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yuming Yin
- Radiology Associates, LLP, 1814 South Alameda Street, Corpus Christi, TX, 78404, USA
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MRI and Arthroscopic Correlation of the Wrist. Sports Med Arthrosc Rev 2017; 25:e18-e30. [PMID: 29095398 DOI: 10.1097/jsa.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since its introduction in 1979, the practice of and indications for wrist arthroscopy in the diagnosis and treatment of pathologic conditions in the wrist continues to grow. Magnetic resonance imaging (MRI) is another commonly used tool to noninvasively examine the anatomy and pathology of the wrist joint. Here, we review the normal wrist anatomy as seen arthroscopically and through MRI. We then examine the various common pathologic entities and define both the arthroscopic findings and correlated MRI findings in each of these states.
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Ochman S, Wieskötter B, Langer M, Vieth V, Raschke MJ, Stehling C. High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary? Arch Orthop Trauma Surg 2017; 137:1443-1450. [PMID: 28808768 DOI: 10.1007/s00402-017-2747-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Indexed: 10/19/2022]
Abstract
INTRODUCTION 3T MRI has become increasingly available for better imaging of interosseous ligaments, TFCC, and avascular necrosis compared with 1.5T MRI. This study assesses the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard. PATIENTS AND METHODS Eighteen patients were examined with 3T MRI using coronal T1-TSE; PD-FS; and coronal, sagittal, and axial contrast-enhanced T1-FFE-FS sequences. Two musculoskeletal radiologists evaluated the images independently. Patients underwent diagnostic arthroscopy. RESULTS The classifications of the cartilage lesions showed good correlations with the arthroscopy findings (κ = 0.8-0.9). In contrast to the arthroscopy, cartilage of the distal carpal row was very good and could be evaluated in all patients on MRI. The sensitivity for the TFCC lesion was 83%, and the specificity was 42% (radiologist 1) and 63% (radiologist 2). For the ligament lesions, the sensitivity and specificity were 75 and 100%, respectively, with a high interobserver agreement (κ = 0.8-0.9). DISCUSSION 3T MRI proved to be of good value in diagnosing cartilage lesions, especially in the distal carpal row, whereas wrist arthroscopy provided therapeutic options. When evaluating the surgical therapeutical options, 3T MRI is a good diagnostic tool for pre-operatively evaluating the cartilage of the distal carpal row.
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Affiliation(s)
- Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany. .,Department of Trauma-, Hand- and Reconstructive Surgery, Westfälische Wilhelms University of Muenster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Germany.
| | - B Wieskötter
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - M Langer
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - V Vieth
- Department of Clinical Radiology, University Hospital, Münster, Germany
| | - M J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - C Stehling
- Department of Clinical Radiology, University Hospital, Münster, Germany
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Zhan HL, Li WT, Bai RJ, Wang NL, Qian ZH, Ye W, Yin YM. High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy. Chin Med J (Engl) 2017; 130:817-822. [PMID: 28345546 PMCID: PMC5381316 DOI: 10.4103/0366-6999.202746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. METHODS Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. RESULTS Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. CONCLUSION High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.
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Affiliation(s)
- Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Rong-Jie Bai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Wei Ye
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Yu-Ming Yin
- MRI and CT Services, Radiology Associates, LLP, Corpus Christi, TX 78411, USA
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van Leerdam RH, Wijffels MME, Reijnierse M, Stomp W, Krijnen P, Schipper IB. The value of computed tomography in detecting distal radioulnar joint instability after a distal radius fracture. J Hand Surg Eur Vol 2017; 42:501-506. [PMID: 28058967 DOI: 10.1177/1753193416682682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study evaluated the value of computed tomography scans for the diagnosis of distal radioulnar joint instability. A total of 46 patients, conservatively treated for a unilateral distal radius fracture, were evaluated. Clinical instability was tested using the stress test and clunk test. A computed tomography scan of both wrists was performed in pronation and supination. Two independent observers reviewed the computed tomography scans using: the radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods. Radiological distal radioulnar joint instability was assessed by comparing the measurements of the injured wrist with those of the contralateral uninjured wrists. A total of 22 patients had clinical instability of whom 12 suffered from pain in the injured wrist. Distal radioulnar joint instability was diagnosed on computed tomography in 29 patients. Reliability analysis between clinical and radiological evaluations showed at best moderate, but generally poor agreement. The diagnostic ability of computed tomography for identifying distal radioulnar joint instability seems limited. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R H van Leerdam
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M M E Wijffels
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Stomp
- 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Krijnen
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - I B Schipper
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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