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Accuracy of magnetic resonance imaging of the wrist for clinically important lesions of the major interosseous ligaments and triangular fibrocartilage complex; correlation with radiocarpal arthroscopy. Skeletal Radiol 2021; 50:1605-1616. [PMID: 33474588 DOI: 10.1007/s00256-020-03701-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To demonstrate the utility of MRI in separating clinically relevant from minor or incidental lesions of the triangular fibrocartilage complex and the major interosseous ligaments in the wrist. MATERIALS AND METHODS In this retrospective study, we identified 89 patients and correlated MRI finding with subsequent arthroscopy. Triangular fibrocartilage complex abnormalities have been subdivided into disc lesions-central and radial-or ulnar-sided tears according to MRI appearances and surgical findings as the clinical and surgical approach is very different. Interosseous ligament tears were subdivided into partial or complete, highlighting the principle of recognising surgically relevant lesions. RESULTS For simple central to radial tears and perforations of the triangular fibrocartilage complex, MRI was 98.3% accurate. MRI identified all peripheral triangular fibrocartilage complex tears seen at arthroscopy; however, the specificity of 66.7% may reflect partly the use of arthroscopy limited to the radiocarpal joint. MRI proved 95.4% accurate for surgically relevant scapholunate interosseous ligament tears and was highly accurate at separating limited from complete lunotriquetral interosseous ligament tears showing 100% accuracy for complete tears. CONCLUSIONS The study shows excellent correlation between MRI and arthroscopic findings that determine surgical relevance with a very high sensitivity for triangular fibrocartilage complex lesions and accurate separation of minor versus surgically relevant ligamentous tears.
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Huflage H, Luetkens KS, Kunz AS, Conrads N, Jakubietz RG, Jakubietz MG, Pennig L, Goertz L, Bley TA, Schmitt R, Grunz JP. Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography. Eur Radiol 2021; 31:9399-9407. [PMID: 34003353 PMCID: PMC8589820 DOI: 10.1007/s00330-021-08024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 01/06/2023]
Abstract
Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers’ confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. Key Points • In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex. • Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions. • Additional radial planes provide greater diagnostic confidence.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rafael Gregor Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Michael Georg Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Radiology, University Hospital LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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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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Kim S, Lee GY, Lee JS. Evaluation of the triangular fibrocartilage: comparison of two-compartment wrist CT arthrography using the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography using the radiocarpal joint. Br J Radiol 2019; 92:20190298. [PMID: 31295006 DOI: 10.1259/bjr.20190298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of two-compartment wrist CT arthrography of the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography of the radiocarpal joint in depiction of the triangular fibrocartilage tear. METHODS From January 2016 to December 2017, two-compartment CT arthrography of 74 consecutive patients (36 females, 38 males; mean age, 37.2 years) and unicompartment CT arthrography of 51 consecutive patients (18 females, 33 males; mean age, 40.1 years) were obtained. All CT arthrography images were independently and blindly evaluated by two radiologists for the presence of the triangular fibrocartilage tear by grade (partial or full thickness) per its locations: central disc proper, central-peripheral junction, proximal and distal laminae of its ulnar attachment. Fisher's exact test was used for a statistical analysis, and a p-value less than 0.05 was considered as significant. The arthroscopic findings of 47 patients (34 patients with two-compartment CT arthrography and 13 patients with unicompartment CT arthrography) were evaluated for calculating sensitivity, specificity, and accuracy. RESULTS All partial and full thickness triangular fibrocartilage tears were identified more commonly by their location except for distal laminae on two-compartment CT arthrography than were unicompartment CT arthrography (p = 0.001-0.022). Two-compartment CT arthrography had high sensitivity (90.9-100%) and low specificity (33.3-76.5%) for detecting central disc proper and proximal lamina tears, comparing with unicompartment CT arthrography. CONCLUSION Two-compartment wrist CT arthrography is more helpful for detecting triangular fibrocartilage tears than unicompartment wrist CT arthrography. ADVANCES IN KNOWLEDGE It could be important to evaluate the ulnar foveal insertion of the TFCC in clinical practice, which plays the most important role in DRUJ instability and ulnar-sided wrist pain. Two-compartment wrist CTA of the DRUJ and RCJ could improve diagnostic sensitivity in the TFC tear in terms of its location and torn degree over that of unicompartment wrist CTA of the RCJ. Two-compartment wrist CTA of the DRUJ and RCJ may be recommended as a diagnostic imaging, rather than unicompartment wrist CTA of the RCJ, when peripheral foveal tear of TFC is suspected, especially in young patients.
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Affiliation(s)
- Sujin Kim
- Department of Radiology, Chung Ang University Hospital
| | | | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung Ang University Hospital
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Lee SH, Yun SJ. Point-of-care wrist ultrasonography in trauma patients with ulnar-sided pain and instability. Am J Emerg Med 2018; 36:859-864. [PMID: 29307765 DOI: 10.1016/j.ajem.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow. MATERIAL AND METHODS A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers. RESULTS Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2-99.1%), specificity (96.8-97.3%), and accuracy (96.9-97.9%); these diagnostic performance values did not differ significantly between reviewers (p=0.58-0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC=0.964; musculoskeletal radiology fellow, ICC=0.976), as was the inter-observer agreement (ICC=0.968). CONCLUSION Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea.
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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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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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Kakar S, Garcia-Elias M. The "Four-Leaf Clover" Treatment Algorithm: A Practical Approach to Manage Disorders of the Distal Radioulnar Joint. J Hand Surg Am 2016; 41:551-64. [PMID: 26944032 DOI: 10.1016/j.jhsa.2016.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/17/2016] [Indexed: 02/02/2023]
Abstract
Most symptomatic distal radioulnar joint (DRUJ) conditions result from derangements to several structures that may include the length, shape, and/or orientation of the articulating surfaces; the cartilage of the DRUJ and/or ulnocarpal joint; the DRUJ and/or ulnocarpal joint ligaments; and the extensor carpi ulnaris and/or pronator quadratus muscle. Once a complete diagnosis is made, often only one of these components is addressed, which results in suboptimal clinical outcomes. In this article, we present a treatment algorithm (the Four-Leaf Clover algorithm) to guide treatment of DRUJ pathology. The Four-Leaf Clover principle is a guiding algorithm, not a document forcing the surgeon to adopt one particular treatment. Its purpose is to provide treating physicians with a checklist that helps ensure that they do not miss any of the different components that need to be addressed for a complete treatment. Using the treatment algorithm, we should achieve satisfactory resolution of patients' symptoms after addressing the particular components in a stepwise approach.
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Affiliation(s)
- Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
| | - Marc Garcia-Elias
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN; Kaplan Institute, Barcelona, Spain
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Magnetic resonance imaging abnormalities after lateral ankle trauma in injured and contralateral ankles. Eur J Radiol 2015; 84:2586-92. [DOI: 10.1016/j.ejrad.2015.09.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/08/2015] [Accepted: 09/27/2015] [Indexed: 12/21/2022]
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de Mooij T, Riester S, Kakar S. Key MR Imaging Features of Common Hand Surgery Conditions. Magn Reson Imaging Clin N Am 2015. [DOI: 10.1016/j.mric.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The optimal imaging protocols for magnetic resonance imaging (MRI) of the wrist ligaments are discussed, including the use of magnetic resonance arthrography, and 3 Tesla (T) versus 1.5 T magnetic field strength. The normal MRI appearance of the triangular fibrocartilage complex, capsular, and interosseous wrist ligaments is briefly covered to point out potential diagnostic pitfalls. Numerous examples of common ligamentous pathology discernible on MRI are provided, along with the latest estimates of diagnostic sensitivity and specificity provided by the literature.
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Affiliation(s)
- Michael D Ringler
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN.
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Utility of magnetic resonance imaging for detection of longitudinal split tear of the ulnotriquetral ligament. J Hand Surg Am 2013; 38:1723-7. [PMID: 23910380 DOI: 10.1016/j.jhsa.2013.05.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist magnetic resonance imaging (MRI) has established utility in the diagnosis of wrist ligament tears, including complete tears of the ulnotriquetral ligament (UTL) and other components of the triangular fibrocartilage complex. A new type of longitudinal split tear of the UTL has recently been described with no imaging correlate. Our aims were to describe putative MRI findings associated with longitudinal UTL split tears and to assess diagnostic accuracy. METHODS We randomly selected 40 patients with arthroscopically proven longitudinal UTL split tears and 20 patients with intact UTLs, all of whom had preoperative 3 T MRI of the same wrist performed, from a list of operative notes spanning from January 1997 through October 2011, filtered with the terms "ulnotriquetral ligament" and "ulnar triquetral ligament." Two musculoskeletal radiologists who were blinded to surgical results and clinical information independently reviewed the exams. They recorded the degree of certainty of whether a longitudinal UTL split tear was present and whether several other hypothesized associated abnormalities were present. RESULTS Overall sensitivity for definitive longitudinal UTL split tear detection on MRI was 58% for reader 1 and 30% for reader 2. Specificity was 60% for both. There were no statistically significant discriminatory findings. CONCLUSIONS Among a selected group of patients who all had wrist arthroscopy, preoperative noncontrast 3 T wrist MRI had poor sensitivity and specificity for detection of the longitudinal split type of UTL tear. To date, MRI may be more helpful to exclude potential alternative diagnoses in the patient with ulnar wrist pain.
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Al-Hiari AA. The role of wrist magnetic resonance arthrography in diagnosing triangular fibrocartilage complex tears: experience at king hussein medical center, jordan. Sultan Qaboos Univ Med J 2013; 13:280-6. [PMID: 23862035 DOI: 10.12816/0003235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/27/2012] [Accepted: 11/26/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. METHODS The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. RESULTS After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). CONCLUSION These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.
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Affiliation(s)
- Asem A Al-Hiari
- Department of Radiology, King Hussein Medical Center, Amman, Jordan
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Mahmood A, Fountain J, Vasireddy N, Waseem M. Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding? Open Orthop J 2012; 6:194-8. [PMID: 22675410 PMCID: PMC3367475 DOI: 10.2174/1874325001206010194] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at a District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month interval between the two procedures. The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthroscopies performed by two upper limb surgeons. Patients who underwent both procedures were identified. The arthrogram reports and operation notes were examined for correlation. Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had 90% sensitivity and 75% specificity. The lunotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 91% sensitivity and 88% specificity. Wrist arthrogram and arthroscopy are both invasive techniques. In cost terms the arthrogram remains cheaper but is superseded by arthroscopy as it is both diagnostic and therapeutic.
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Affiliation(s)
- Aatif Mahmood
- Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK
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Iordache SD, Rowan R, Garvin GJ, Osman S, Grewal R, Faber KJ. Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am 2012; 37:98-103. [PMID: 22129657 DOI: 10.1016/j.jhsa.2011.10.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) of the wrist is increasingly used in the diagnosis of ulnar-sided wrist pain; however, its efficacy in this setting still needs clarification. The purposes of this study were to investigate the prevalence of abnormal MRI findings in the triangular fibrocartilage complex (TFCC) in asymptomatic volunteers and to provide the clinician with comparative data when interpreting MRI results. METHODS A total of 103 asymptomatic volunteers underwent imaging of the wrist using a 1.9-T MR scanner and a send-receive birdcage quadrature coil. The images were evaluated by 3 independent interpreters, 2 musculoskeletal radiologists, and 1 orthopedic hand surgeon. We noted details regarding the TFCC morphology and the presence, characteristics, and location of any TFCC abnormality. RESULTS The TFCC was considered abnormal in 39 wrists. The scans were abnormal in 31 subjects younger than 50 years of age, in 5 subjects 50 to 59 years of age, and in all subjects older than 60 years of age (3 subjects). We diagnosed a complete tear of the TFCC in 23 wrists. An increase in age was correlated with an abnormal TFCC (r(pb) = 0.23; P = .016). CONCLUSIONS The prevalence of incidental TFCC findings in MRI scans of asymptomatic subjects is high. The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. Imaging results must be viewed in the context of the clinical history and physical examination. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Sorin D Iordache
- Department of Surgery, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
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Smith J, Rizzo M, Sayeed YA, Finnoff JT. Sonographically guided distal radioulnar joint injection: technique and validation in a cadaveric model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1587-1592. [PMID: 22039032 DOI: 10.7863/jum.2011.30.11.1587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Distal radioulnar joint (DRUJ) disorders are uncommon but important causes of ulnar-sided wrist pain and disability. Fluoroscopically guided injections may be performed to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Sonographic guidance may provide a favorable alternative to fluoroscopic guidance for distal DRUJ injections. This report describes and validates a sonographically guided technique for DRUJ injections in an unembalmed cadaveric model. An experienced clinician used sonographic guidance to inject diluted colored latex into the DRUJs of 10 unembalmed cadaveric specimens. Subsequent dissection by a fellowship-trained hand surgeon confirmed accurate injections in all 10 specimens. Two cases of ulnocarpal flow, indicative of triangular fibrocartilage injury, were noted during injection and subsequently confirmed during dissection. Clinicians should consider using sonographic guidance to perform DRUJ injections when clinically indicated. Further research should explore the efficacy of sonographically guided DRUJ injections to treat patients with painful DRUJ syndromes or to evaluate the triangular fibrocartilage complex in patients with ulnar wrist pain syndromes.
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Affiliation(s)
- Jay Smith
- Departments of Physical Medicine and Rehabilitation and Radiology, W14, Mayo Clinic College of Medicine, Rochester, MN 55905 USA.
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Normal and Variant Anatomy of the Wrist and Hand on MR Imaging. Magn Reson Imaging Clin N Am 2011; 19:595-608; ix. [DOI: 10.1016/j.mric.2011.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nordmeyer-Massner JA, Wyss M, Andreisek G, Pruessmann KP, Hodler J. In vitro and in vivo comparison of wrist MR imaging at 3.0 and 7.0 tesla using a gradient echo sequence and identical eight-channel coil array designs. J Magn Reson Imaging 2011; 33:661-7. [DOI: 10.1002/jmri.22419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Malone WJ, Snowden R, Alvi F, Klena JC. Pitfalls of Wrist MR Imaging. Magn Reson Imaging Clin N Am 2010; 18:643-62. [DOI: 10.1016/j.mric.2010.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Faber KJ, Iordache S, Grewal R. Magnetic resonance imaging for ulnar wrist pain. J Hand Surg Am 2010; 35:303-7. [PMID: 20141901 DOI: 10.1016/j.jhsa.2009.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Kenneth J Faber
- Department of Surgery, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
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Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39:837-57. [PMID: 20012039 PMCID: PMC2904904 DOI: 10.1007/s00256-009-0842-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 11/14/2009] [Accepted: 11/17/2009] [Indexed: 02/02/2023]
Abstract
Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.
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Affiliation(s)
- Atsuya Watanabe
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Felipe Souza
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter S. Vezeridis
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Hiroshi Yoshioka
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA ,Department of Radiological Sciences, University of California-Irvine, Irvine, CA USA ,Department of Radiological Sciences, UC Irvine Medical Center, 101 City Drive South, Route 140, Orange, CA 92868 USA
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Partial versus partial-thickness tears of the scapholunate and lunatotriquetral ligaments. AJR Am J Roentgenol 2009; 193:W469. [PMID: 19843730 DOI: 10.2214/ajr.09.2898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pesquer L, Scepi M, Bihan M, Vialle R, Richer JP, Roumy J, Tasu JP. Normal ultrasound anatomy of the triangular fibrocartilage of the wrist: a study on cadavers and on healthy subjects. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:194-198. [PMID: 18855934 DOI: 10.1002/jcu.20529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report the normal sonographic anatomy of the triangular fibrocartilage (TFC) of the wrist in cadavers and volunteers. METHOD Five hands from cadavers were examined sonographically before and after wrist dissection, during which the TFC was marked with surgical wires. Twenty volunteers without wrist limitation or pain, and without any history of wrist disease or inflammatory arthritis (mean age, 26 years (range,19-45 years) were also examined. RESULTS Sonograms showed that the meniscus and the TFC were clearly separated. The meniscus appeared as a triangular structure that was homogeneous and slightly hyperechoic. Compared with the meniscus, the TFC appeared hypoechoic. The same patterns were observed for cadavers and volunteers. In 3 volunteers (15%), the TFC was not visualized. CONCLUSIONS Using high-resolution ultrasound systems, the TFC can be separated from meniscus. However, visualization of the TFC remains limited due to its deep location and the presence of acoustic shadowing from bony structures.
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Affiliation(s)
- Lionel Pesquer
- Department of Radiology, CHU Jean Bernard, Poitiers, France
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Maizlin ZV, Brown JA, Clement JJ, Grebenyuk J, Fenton DM, Smith DE, Jacobson JA. MR arthrography of the wrist: controversies and concepts. Hand (N Y) 2009; 4:66-73. [PMID: 19048349 PMCID: PMC2654947 DOI: 10.1007/s11552-008-9149-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 10/24/2008] [Indexed: 12/21/2022]
Abstract
Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. Thirty-one consecutive direct magnetic resonance arthrographic examinations of the wrist using a wrist surface coil were performed for the assessment of the TFCC and intrinsic ligaments on a 1.5-T MR imaging system (Signa; 16 channel, Excite, GE Healthcare, Milwaukee, WI, USA). All patients had wrist pain, and in six cases, there was associated clinical carpal instability. The presence, location, and extent of TFCC, scapholunate ligament (SLL), and lunotriquetral ligament (LTL) lesions on T1 fat-saturated, multiplanar gradient recalled (MPGR) and short tau inversion recovery (STIR) images were identified, compared, and analyzed. Forty-one lesions of the TFCC, SLL, and LTL were visualized on contrast-sensitive (T1 fat-saturated) images in 23/31 (74.2%) patients. Twenty-one lesions of the TFCC and intrinsic ligaments were visualized on noncontrast-sensitive (MPGR and STIR) images (15 tears of the TFCC and six tears of the SLL and LTL). All of these lesions were seen on T1 fat-saturated images; 48.8% (20/41) lesions seen on T1 fat-saturated images (eight tears of TFCC and 12 tears of SLL and LTT) were not seen on MPGR and/or STIR images. Superior contrast resolution, joint distention, and the flow of contrast facilitate the diagnosis of lesions of the TFCC and intrinsic ligaments on contrast-sensitive sequences making MRA the preferred modality for imaging internal derangements of the wrist. Little agreement exists regarding the value and location of perforations of the intrinsic ligaments given that both traumatic and degenerative perforations may be symptomatic. Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain.
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Affiliation(s)
- Zeev V Maizlin
- Department of Radiology, McMaster University Medical Centre, Hamilton, ON, Canada.
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Moser T, Dosch JC, Moussaoui A, Buy X, Gangi A, Dietemann JL. Multidetector CT Arthrography of the Wrist Joint: How to Do It. Radiographics 2008; 28:787-800; quiz 911. [DOI: 10.1148/rg.283075087] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The unique ability of magnetic resonance (MR) imaging to visualize injuries of bone, cartilage, bone marrow, and supporting soft tissue structure makes it ideally suited for the evaluation of musculoskeletal trauma. Magnetic resonance imaging also offers exquisitely detailed anatomical information on the musculoskeletal system. The widespread availability of MR imaging and the constantly improving technology make it the imaging modality of choice for the patients with a musculoskeletal trauma. This review discusses the role and applications of MR imaging for musculoskeletal trauma. It covers traumatic conditions of the musculoskeletal system, including hemarthrosis, lipohemarthrosis, stress fracture, occult fractures, cartilage injuries, the muscle and tendon trauma, avulsion injuries, extensor mechanism injuries, and traumatic conditions of joints.
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Affiliation(s)
- Joong Mo Ahn
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Rüegger C, Schmid MR, Pfirrmann CWA, Nagy L, Gilula LA, Zanetti M. Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol 2007; 188:187-92. [PMID: 17179363 DOI: 10.2214/ajr.05.2056] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although central tears of the triangular fibrocartilage are easily seen on imaging, peripheral tears of the ulnar attachment are frequently missed. The aim of this study was to evaluate the accuracy of MR arthrography of the distal radioulnar joint in depiction of peripheral tears of the triangular fibrocartilage. MATERIALS AND METHODS Forty-one patients (18 women, 23 men; mean age, 38 years; age range, 18-60 years) underwent MR arthrography and wrist arthroscopy. For MR arthrography, iopamidol (300 mg I/mL) and gadopentetate dimeglumine (4 mmol/L) were injected into the distal radioulnar joint. Consensus review of both MR arthrograms and conventional arthrograms was performed by two experienced musculoskeletal radiologists. Presence or absence of communicating and noncommunicating tears of the ulnar attachment of the triangular fibrocartilage was recorded. Arthroscopy was used as the standard of reference for determining sensitivity, specificity, and accuracy in detection of tears of the ulnar attachment. RESULTS At MR arthrography, communicating tear of the ulnar attachment was diagnosed in three patients, noncommunicating tear in 19 patients, and normal attachment in 19 patients. Arthroscopy revealed peripheral tear of the triangular fibrocartilage in all three patients with communicating tear, in 14 of 19 patients with noncommunicating tear, and in three of 19 patients with normal attachment. The sensitivity was 85% (17/20), specificity was 76% (16/21), and accuracy was 80% (33/41). CONCLUSION MR arthrography of the distal radioulnar joint is accurate in depiction of peripheral tears of the ulnar attachment of the triangular fibrocartilage. These tears often appear as noncommunicating tears extending from the distal radioulnar joint into the triangular fibrocartilage.
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Affiliation(s)
- Christoph Rüegger
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
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Guerini H, Drapé JL, Le Viet D, Thevenin F, Roulot E, Pessis E, Montalvan B, Feydy A, Chevrot A. Imagerie du poignet du sportif. ACTA ACUST UNITED AC 2007; 88:111-28. [PMID: 17299354 DOI: 10.1016/s0221-0363(07)89800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.
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Affiliation(s)
- H Guerini
- Service de Radiologie B, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014 Paris.
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Zanetti M, Saupe N, Nagy L. Role of MR imaging in chronic wrist pain. Eur Radiol 2006; 17:927-38. [PMID: 16932876 DOI: 10.1007/s00330-006-0365-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 05/19/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienböck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain.
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Affiliation(s)
- Marco Zanetti
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
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Pfirrmann CWA, Zanetti M. Variants, pitfalls and asymptomatic findings in wrist and hand imaging. Eur J Radiol 2006; 56:286-95. [PMID: 16298674 DOI: 10.1016/j.ejrad.2005.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/10/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
Anatomic variants of the bones, ligaments, tendons and muscles are frequent findings in imaging of the wrist and hand. Many findings especially changes in the triangular fibrocartilage (TFC) and the interosseous ligaments are asymptomatic, their incidence is increasing with age, and they are frequently found bilaterally. Abnormalities such as increased signal within tendons are common in asymptomatic subjects. They may be explained by normal physiology, anatomical variability, MR artifacts or true abnormalities without clinical importance. Although it is not always possible to differentiate variants and artifacts from clinically relevant findings it is important to know their potential etiology and clinical importance and not to over report them as abnormality requiring additional imaging or treatment.
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Affiliation(s)
- Christian W A Pfirrmann
- University Hospital Balgrist, Radiology, University of Zurich Switzerland, Forchstrasse 340, CH-8008 Zurich, Switzerland.
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Berná-Serna JD, Martínez F, Reus M, Alonso J, Domenech-Ratto G. Wrist arthrography: a simple method. Eur Radiol 2005; 16:469-72. [PMID: 16021455 DOI: 10.1007/s00330-005-2834-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 05/10/2005] [Accepted: 06/02/2005] [Indexed: 11/29/2022]
Abstract
A technique of wrist arthrography is presented using an adhesive marker-plate with radiopaque coordinates to identify precisely sites for puncture arthrography of the wrist and to obviate the need for fluoroscopic guidance. Radiocarpal joint arthrography was performed successfully in all 24 cases, 14 in the cadaveric wrists and 10 in the live patients. The arthrographic procedure described in this study is simple, safe, and rapid, and has the advantage of precise localisation of the site for puncture without need for fluoroscopic guidance.
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Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Hospital, 30120, El Palmar (Murcia), Spain,
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Cerezal L, Abascal F, García-Valtuille R, Del Piñal F. Wrist MR Arthrography: How, Why, When. Radiol Clin North Am 2005; 43:709-31, viii. [PMID: 15893533 DOI: 10.1016/j.rcl.2005.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MR imaging of the wrist frequently represents a diagnostic challenge for radiologists because of the complex anatomy of this joint, small size of its components, and little known pathologic conditions. MR arthrography combines the advantages of conventional MR imaging and arthrography by improving the visualization of small intra-articular abnormalities. This article reviews the current role of MR arthrography in the evaluation of wrist joint disorders considering the relevant aspects of anatomy, techniques, and applications.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Instituto Radiológico Cántabro, Clínica Mompía, Mompía, Cantabria 39109, Spain.
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Abstract
Lesions of the TFCC are currently a diagnostic and therapeutic challenge. Disc-injuries are often not identified and, therefore, acute ruptures are unfortunately not always immediately repaired. Moreover, therapeutic measures are still sparse and informative trial results are lacking. An anatomical, pathological, diagnostic and therapeutic comparison with the meniscus of the knee is possible.
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Keogh CF, Wong AD, Wells NJ, Barbarie JE, Cooperberg PL. High-Resolution Sonography of the Triangular Fibrocartilage:Initial Experience and Correlation with MRI and Arthroscopic Findings. AJR Am J Roentgenol 2004; 182:333-6. [PMID: 14736657 DOI: 10.2214/ajr.182.2.1820333] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of our study was to compare the findings of high-resolution sonography of the triangular fibrocartilage with those of MRI and arthroscopy. SUBJECTS AND METHODS. Thirteen patients with clinically suspected triangular fibrocartilage tears prospectively underwent sonography, followed by MRI, of their wrists. Triangular fibrocartilage tears were classified as predominantly ulnar or predominantly radial. Only the surgeon was aware of the results of both studies, and eight patients subsequently underwent arthroscopy. The findings of the different techniques were compared. RESULTS For the presence or absence of a tear, seven (87.5%) of eight sonographic examinations correlated with arthroscopy, and 11 (84.6%) of 13 sonographic examinations correlated with MRI. Sonography missed one small radial tear that was detected at arthroscopy and MRI, but sonography showed an ulnar tear in triangular fibrocartilage that appeared normal on MRI. CONCLUSION High-resolution sonography shows good correlation with MRI and arthroscopy for the evaluation of triangular fibrocartilage tears. Sonography has the potential to be a rapid and cost-effective means of diagnosing tears of the triangular fibrocartilage, particularly those involving the ulnar aspect of the cartilage.
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Affiliation(s)
- Ciaran F Keogh
- Department of Radiology, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
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Zanetti M, Pfirrmann CWA, Schmid MR, Romero J, Seifert B, Hodler J. Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 2003; 181:635-41. [PMID: 12933452 DOI: 10.2214/ajr.181.3.1810635] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence of MR abnormalities of the knee on the symptomatic and contralateral asymptomatic sides in patients with suspected meniscal tears. SUBJECTS AND METHODS. One hundred patients (mean age, 42.7 years; range, 18-73 years) referred for suspected meniscal tears were prospectively examined with MRI of both knees when the contralateral knee was asymptomatic. The prevalence of various types of meniscal tears and other MR abnormalities was determined. RESULTS Meniscal tears were found in 57 symptomatic knees and in 36 contralateral asymptomatic knees. In those 57 patients with a meniscal tear on the symptomatic side, the prevalence of asymptomatic tears in the contralateral side was 63% (36/57). Horizontal or oblique meniscal tears were found medially in 32 and laterally in 11 symptomatic knees, and medially in 29 and laterally in eight asymptomatic knees. Radial, vertical, complex, or displaced tears were found medially in 18 and laterally in five symptomatic knees, and medially in five and laterally in none of the asymptomatic knees. Collateral ligament abnormalities were found in 53 symptomatic knees and in six asymptomatic knees. Pericapsular soft-tissue abnormalities were found in 64 symptomatic and in 12 asymptomatic knees. Edema-like bone marrow abnormalities were found in 36 symptomatic and in three asymptomatic knees. CONCLUSION Horizontal or oblique meniscal tears are frequently encountered in both asymptomatic and symptomatic knees and may not always be related to symptoms. However, radial, vertical, complex, or displaced meniscal tears and abnormalities of the collateral ligaments, pericapsular soft tissues, and bone marrow are found almost exclusively on the symptomatic side and appear to be clinically more meaningful.
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Affiliation(s)
- Marco Zanetti
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstr. 340, CH-8008 Zurich, Switzerland.
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Pfirrmann CWA, Zanetti M, Hodler J. Joint magnetic resonance imaging: normal variants and pitfalls related to sports injury. Radiol Clin North Am 2002; 40:167-80. [PMID: 12118819 DOI: 10.1016/s0033-8389(02)00003-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MR imaging abnormalities, such as increased signal within normally hypointense structures, form and attachment abnormalities, fluid collections in joints, tendon sheaths and bursa, or even tumors, such as Morton's neuromas, are common in asymptomatic volunteers. They may be explained by normal physiology, anatomic variability, MR imaging artifacts, or true abnormalities without clinical importance. Although it is not always possible to differentiate such variants or artifacts from clinically relevant findings, it is important to know their potential cause and clinical importance and not to over-report them as abnormality requiring additional imaging or treatment. Thorough knowledge of normal anatomy is crucial in this situation.
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Haims AH, Schweitzer ME, Morrison WB, Deely D, Lange R, Osterman AL, Bednar JM, Taras JS, Culp RW. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol 2002; 178:419-22. [PMID: 11804907 DOI: 10.2214/ajr.178.2.1780419] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The treatment of peripheral tears of the triangular fibrocartilage complex is radically different from the more typical central, degenerative tears. To our knowledge, no reports in the imaging literature specifically evaluate tears of the ulnar attachment of the triangular fibrocartilage complex. We evaluated the accuracy of MR imaging in these patients. MATERIALS AND METHODS Eighty-six MR imaging examinations of the wrist (41 indirect MR arthrograms and 45 unenhanced MR images) were evaluated: 20 wrists with surgically confirmed peripheral triangular fibrocartilage complex tears and 66 wrists with surgically documented normal ulnar attachment. These cases were evaluated by three experienced musculoskeletal radiologists, who were unaware of the surgical findings, to assess the presence of peripheral triangular fibrocartilage complex tears or fluid signal at the ulnar attachment of the triangular fibrocartilage complex. RESULTS The sensitivity for evaluation of the peripheral triangular fibrocartilage complex tear was 17%, with a specificity of 79% and an accuracy of 64%. High signal intensity at the ulnar insertion of the triangular fibrocartilage complex as a marker for tear showed a sensitivity of 42%, a specificity of 63%, and an accuracy of 55%. Weighted kappa values revealed only fair agreement among the three observers. CONCLUSION MR imaging does not adequately reveal the peripheral attachment of the triangular fibrocartilage complex.
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Affiliation(s)
- Andrew H Haims
- Department of Radiology, Yale University School of Medicine, 333 Cedar St., P. O. Box 208042, New Haven, CT 06520-8042, USA
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Zanetti M, Gilula LA, Jacob HA, Hodler J. Palmar tilt of the distal radius: influence of off-lateral projection initial observations. Radiology 2001; 220:594-600. [PMID: 11526254 DOI: 10.1148/radiol.2202001699] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of slight off-lateral positioning of the wrist on measurements of the palmar tilt of the distal radius on lateral views and to determine how this effect can be corrected quantitatively. MATERIALS AND METHODS Seven cadaveric forearms in neutral and various oblique positions (5 degrees, 10 degrees, 15 degrees, 20 degrees ) of supination and pronation were examined with lateral radiography. The palmar tilt of the distal radius measured on the radiographs was correlated with each position of the wrist and the distance between the position of the palmar cortex of the pisiform bone (P) and a reference point (point 0), which was defined as the midpoint within the interval between palmar cortices of the distal scaphoid pole and of the capitate head (P0 distance). The same measurements were performed on 11 wrists during arthrography. RESULTS The apparent palmar tilt of the distal radius increased with supination of the forearm. Regression analysis with the P0 distance as independent and palmar tilt as dependent variables resulted in a slope of 0.95 in the seven cadaveric wrists and of 0.92 in the 11 wrist arthrograms. The squares of the correlation coefficients (R(2)) were 0.89 in cadaveric wrists and 0.69 in 11 wrist arthrograms. CONCLUSION Differences in the palmar tilt produced by off-lateral projections of the wrist can be estimated from the measured difference of the P0 distance. A 1-mm difference in the P0 distance corresponds to a difference in the palmar tilt of approximately 1 degrees.
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Affiliation(s)
- M Zanetti
- Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
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