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Oca Pernas R, Fernández Cantón G. Direct MR arthrography without image guidance: a practical guide, joint-by-joint. Skeletal Radiol 2024:10.1007/s00256-024-04709-0. [PMID: 38801542 DOI: 10.1007/s00256-024-04709-0] [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: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
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Affiliation(s)
- Roque Oca Pernas
- Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain.
- Department of Radiology, Mutualia, Bilbao, Spain.
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Krastman P, Kraan G, van Kooij YE, Bierma-Zeinstra SMA, Runhaar J. Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study. J Hand Ther 2024:S0894-1130(23)00174-6. [PMID: 38360484 DOI: 10.1016/j.jht.2023.12.002] [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: 03/17/2023] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited. PURPOSE To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints. STUDY DESIGN An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed. METHODS In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario. RESULTS Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain. CONCLUSIONS This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Gerald Kraan
- Department of Orthopedic Surgery, Reinier de Graaf Groep, Delft, the Netherlands.
| | - Yara E van Kooij
- Xpert Handtherapie, Xpert Clinics, Zeist, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
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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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Cerezal L, Del Piñal F, Atzei A, Schmitt R, Becce F, Klich M, Bień M, de Jonge MC, Teh J, Boutin RD, Toms AP, Omoumi P, Fritz J, Bazzocchi A, Shahabpour M, Zanetti M, Llopis E, Blum A, Lalam RK, Reto S, Afonso PD, Mascarenhas VV, Cotten A, Drapé JL, Bierry G, Pracoń G, Dalili D, Mespreuve M, Garcia-Elias M, Bain GI, Mathoulin CL, Van Overstraeten L, Szabo RM, Camus EJ, Luchetti R, Chojnowski AJ, Gruenert JG, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev IO, van Schoonhoven J, Goehtz F, Sudoł-Szopińska I, Dietrich TJ. Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries. Eur Radiol 2023; 33:6322-6338. [PMID: 37191922 DOI: 10.1007/s00330-023-09698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. METHODS Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of "0," "5," and "10" reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of "8" or higher for 80% or more of the panelists. RESULTS Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds. CONCLUSIONS Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC. CLINICAL RELEVANCE STATEMENT MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries. KEY POINTS • Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability. • MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions. • The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC.
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Affiliation(s)
- Luis Cerezal
- Radiology Department, Diagnóstico Médico Cantabria (DMC), Castilla 6-Bajo, 39002, Santander, Spain.
| | - Francisco Del Piñal
- Instituto de Cirugía Plástica Y de La Mano, Serrano 58 1B, 28001, Madrid, Spain
| | - Andrea Atzei
- Pro-Mano, Treviso, Italy
- Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy
| | - Rainer Schmitt
- Department of Radiology, University Hospital LMU Munich, Ziemssenstraße 5, 80336, München, Germany
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Maciej Klich
- Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland
| | - Maciej Bień
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Robert Downey Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| | - Andoni Paul Toms
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marco Zanetti
- Kantonsspital Baden, Im Ergel 1, CH-5404, Baden, Switzerland
| | - Eva Llopis
- Hospital de La Ribera. IMSKE. Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Radhesh Krishna Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Sutter Reto
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Radiology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - P Diana Afonso
- Imaging Center, Radiology Department, Musculoskeletal Imaging Unit, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
- Hospital Particular da Madeira, HPA, Madeira, Portugal
| | - Vasco V Mascarenhas
- Imaging Center, Radiology Department, Musculoskeletal Imaging Unit, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
- AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Anne Cotten
- Musculoskeletal Radiology Department, Lille University Hospital Center, 59037, Lille, France
- Lille University School of Medicine, Lille, France
| | - Jean-Luc Drapé
- Service de Radiologie B, AP-HP Centre, Groupe Hospitalier Cochin, Université de Paris, 75014, Paris, France
| | - Guillaume Bierry
- MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Grzegorz Pracoń
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, KT18 7EG, London, UK
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Creu Blanca, Pº Reina Elisenda 57, 08022, Barcelona, Spain
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders Medical Centre and Flinders University, Adelaide, South, Australia
| | | | - Luc Van Overstraeten
- Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik 808, Brussels, Belgium
| | - Robert M Szabo
- Department of Orthopaedic Surgery, Health System, University of California Davis, 4800 Y Street, Sacramento, CA, 95817, USA
| | - Emmanuel J Camus
- IMPPACT Hand Surgery Unit, Clinique de Lille Sud, 94 Bis Rue Gustave Delory, Lesquin, France
- Laboratoire d'anatomie Fonctionnelle, ULB, Bruxelles, Belgium
| | | | - Adrian Julian Chojnowski
- Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Joerg G Gruenert
- Department of Hand and Plastic Surgery Berit Klinik, Klosterstrasse 19, 9403, Goldach, Switzerland
| | - Piotr Czarnecki
- Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Ul. 28 Czerwca 1956R. Nr 135/147, 61-545, Poznań, Poland
| | - Fernando Corella
- Orthopedic and Trauma Department. Hospital, Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain
- Hand Surgery Unit. Hospital Universitario Quirónsalud Madrid, Madrid, Spain
- Surgery Department, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ladislav Nagy
- Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Japan
| | - Igor O Golubev
- Hand and Microsurgery Division, Priorov Central Institute of Traumatology and Orthopedy, Moscow, Russia
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
| | - Tobias Johannes Dietrich
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Wang Z, Chen S, Liu B, Qian Z, Zhu J, Wang Q. Abnormal MRI signal intensity of the triangular fibrocartilage complex in asymptomatic wrists. J Hand Surg Eur Vol 2023; 48:326-332. [PMID: 36482744 DOI: 10.1177/17531934221141986] [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: 12/13/2022]
Abstract
We investigated abnormal MRI findings of the triangular fibrocartilage complex in 154 asymptomatic volunteers (21-79 years). Except prevalence, we focused on the morphological features of abnormal signals in relation to age. The majority of full-thickness tears were located in the articular disc (63 participants). The incidence of disc perforation with characteristics of ulnar impaction syndrome increased significantly with age. Asymptomatic full-thickness tears of the ulnar attachment were found in ten participants (seven over 60 years old). The proximal and distal laminae of the ulnar attachment could not be differentiated in 36 participants. In conclusion, MRI is of limited value for the elderly in diagnosing triangular fibrocartilage disorders. For young subjects, MRI is still valuable, especially in diagnosing ulnar detachment, although the ability to distinguish between proximal and distal laminae remains questionable. Disc perforations in volunteers mimicked ulnar impaction syndrome, therefore age, clinical signs and other factors should also be considered in clinical diagnosis.Level of evidence: III.
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Affiliation(s)
- Zhixin Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Shanlin Chen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Zhanhua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Jin Zhu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Qianqian Wang
- Beijing Jishuitan Hospital, Beijing Institute of Trauma and Orthopedics, Beijing, China
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Verhiel SHWL, Blackburn J, Ritt MJPF, Simeone FJ, Chen NC. MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain. Hand (N Y) 2022; 17:483-490. [PMID: 32686539 PMCID: PMC9112747 DOI: 10.1177/1558944720937369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. Methods: We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. Results: We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis (P = .033), extensor carpi ulnaris (ECU) pathology (P = .028), and ulnar styloid fractures (P = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint (P = .040), more ulnocarpal abutment (P = .0081), and more degenerative tears (P < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. Conclusions: We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.
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Affiliation(s)
- Svenna H. W. L. Verhiel
- Massachusetts General Hospital, Boston, USA,Amsterdam UMC, location VUmc, The Netherlands,Svenna H. W. L. Verhiel, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
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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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Cunningham DJ, Pidgeon TS, Saltzman EB, Mather RC, Ruch DS. The Value Added of Advanced Imaging in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Pathology. J Hand Surg Am 2022; 47:19-30.e8. [PMID: 34481677 DOI: 10.1016/j.jhsa.2021.06.027] [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: 07/04/2019] [Revised: 04/12/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Pathology of the triangular fibrocartilage complex is a prevalent cause of ulnar-sided wrist pain that presents a diagnostic challenge. We hypothesized that a history and physical examination (H&P) would be more cost-effective alone or with diagnostic injection than with magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. METHODS A simple-chain decision analysis model was constructed to assess simulated subjects with ulnar-sided wrist pain and normal radiographs using several diagnostic algorithms: H&P alone, H&P + injection, H&P with delayed advanced imaging (MRI or MRA), and H&P + injection with delayed advanced imaging (MRI or MRA). Three years after diagnosis, effectiveness was calculated in Disabilities of the Arm, Shoulder, and Hand-adjusted life years. Costs were extracted from a commercial insurance database using US dollars. A probabilistic sensitivity analysis with 10,000 second-order trials with sampling of parameter distributions was performed. One-way and 2-way sensitivity analyses were performed. RESULTS All strategies had similar mean effectiveness between 2.228 and 2.232 Disabilities of the Arm, Shoulder, and Hand-adjusted life years, with mean costs ranging from $5,584 (H&P alone) to $5,980 (H&P, injection, and MRA). History and physical examination alone or with injection were the most cost-effective strategies. History and physical examination alone was the most preferred diagnostic strategy, though H&P + injection and H&P with delayed MRA were preferred with adjustments in willingness-to-pay and parameter inputs. As willingness-to-pay increased considerably (>$65,000 per Disabilities of the Arm, Shoulder, and Hand-adjusted life year), inclusion of MRA became the most favorable strategy. CONCLUSIONS Advanced imaging adds costs and provides minimal increases in effectiveness in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. The most cost-effective strategy is H&P, with or without diagnostic injection. Magnetic resonance arthrogram may be favored in situations with a high willingness-to-pay or poor examination characteristics. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis IV.
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Affiliation(s)
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | | | | | - David S Ruch
- Department of Orthopaedic Surgery, Duke University, Durham, NC
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Luetkens KS, Grunz JP. Reply to the Letter to the Editor: "Comments about contrast-enhanced MRI of the wrist". Eur J Radiol 2021; 144:110011. [PMID: 34735827 DOI: 10.1016/j.ejrad.2021.110011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
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Rabinovich RV, Zelouf DS. Failed Triangular Fibrocartilage Complex Repair and Reconstruction. Hand Clin 2021; 37:507-515. [PMID: 34602130 DOI: 10.1016/j.hcl.2021.06.003] [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
Unsuccessful triangular fibrocartilage complex (TFCC) repair or reconstruction is poorly defined, often stemming from multiple causes, both patient and surgeon-related. Complete evaluation of the patient's psychosocial status and involvement in any litigation claims is essential, as is a thorough history, physical examination, and imaging workup to accurately diagnose TFCC injury, along with any concomitant wrist pathology. Awareness of common complications and technical errors is critical, and preventive treatment strategies should be implemented to minimize these events.
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Affiliation(s)
- Remy V Rabinovich
- New York Hand and Wrist Center - Northwell Health, 210 East 64th Street, 5th Floor, New York, NY 10065, USA.
| | - David S Zelouf
- Philadelphia Hand to Shoulder Center and Thomas Jefferson University Hospitals, 834 Chestnut Street, Suite G-114, Philadelphia, PA 19107, USA
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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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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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14
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[The ulnocarpal complex : New clinical and radiological considerations]. Radiologe 2021; 61:343-350. [PMID: 33620507 DOI: 10.1007/s00117-021-00824-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/28/2022]
Abstract
CLINICAL ISSUE The triangular fibrocartilage complex (TFCC) is an anatomically complex structure with high demands on spatial and contrast resolution in imaging. RADIOLOGICAL METHODS The central, predominantly avascular articular disc can be distinguished from the ligamentous, vascularized periphery. Imaging methods include magnetic resonance imaging (MRI, preferably contrast-enhanced) as well as MR and computed tomography (CT) arthrography. DIAGNOSTIC INNOVATIONS While high-resolution MRI represents the standard diagnostic tool for the TFCC in general, arthrographic imaging is particularly useful for assessment of the foveal (proximal) lamina of the TFCC. In radiological reporting, the convergence of the TFCC periphery towards the ulnar styloid process and the ulnar fovea must be considered. ACHIEVEMENTS The Palmer classification is suitable for evaluating lesions of the articular disc, whereas the Atzei classification is superior for lesions of the ulnar TFCC insertions. PRACTICAL RECOMMENDATION Use of a high-resolution examination technique and anatomy-based image interpretation are important for reliable MRI of the TFCC.
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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
PURPOSE OF REVIEW Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adults and poses clinical challenges which have placed it at the forefront of imaging and orthopedics. Diagnostic hip imaging has dramatically changed in the past years, with the arrival of new imaging techniques and the development of magnetic resonance imaging (MRI). This article reviews the current state-of-the-art clinical routine of individuals with suspected FAI, limitations, and future directions that show promise in the field of musculoskeletal research and are likely to reshape hip imaging in the coming years. RECENT FINDINGS The largely unknown natural disease course, especially in hips with FAI syndrome and those with asymptomatic abnormal morphologies, continues to be a problem as far as diagnosis, treatment, and prognosis are concerned. There has been a paradigm shift in recent years from bone and soft tissue morphological analysis towards the tentative development of quantitative approaches, biochemical cartilage evaluation, dynamic assessment techniques and, finally, integration of artificial intelligence (AI)/deep learning systems. Imaging, AI, and hip preserving care will continue to evolve with new problems and greater challenges. The increasing number of analytic parameters describing the hip joint, as well as new sophisticated MRI and imaging analysis, have carried practitioners beyond simplistic classifications. Reliable evidence-based guidelines, beyond differentiation into pure instability or impingement, are paramount to refine the diagnostic algorithm and define treatment indications and prognosis. Nevertheless, the boundaries of morphological, functional, and AI-aided hip assessment are gradually being pushed to new frontiers as the role of musculoskeletal imaging is rapidly evolving.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Avenida Lusíada 100, 1500-650, Lisbon, Portugal.
| | - António Caetano
- Radiology Department, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, Rua da Beneficiência, 8, 1050-099, Lisbon, Portugal
| | - Pedro Dantas
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Rua Mario Botas, 1998-018, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Grupo Luz Saúde, Avenida Lusiada 100, 1500-650, Lisbon, Portugal
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18
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Schmitt R. [Radiology of the distal radioulnar joint and the ulnocarpal complex]. DER ORTHOPADE 2019; 47:637-646. [PMID: 29915995 DOI: 10.1007/s00132-018-3594-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
X-ray images exposed in neutral position and radiocarpally centred are essential in imaging of the distal radioulnar joint (DRUJ). The anatomic orientation of the DRUJ is favourable for acquiring transaxial scans to display its anatomy, subtle derangements, osteoarthritis and intra-articular fractures free from superpositions. The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the DRUJ. Provided that a focused clinical indication is given, high-resolution images are acquired, and an intra-venous or intra-articular contrast-agent is applied, all TFCC structures and destabilizing lesions can be displayed with the use of CT and MRI.
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Affiliation(s)
- R Schmitt
- Klinik für Diagnostische und Interventionelle Radiologie, Herz- und Gefäß-Klinik GmbH Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt, Deutschland. .,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
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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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The Relevance of Ulnar-Sided Contrast Extravasation During Radiocarpal Joint Wrist Arthrography. AJR Am J Roentgenol 2019; 212:614-619. [DOI: 10.2214/ajr.18.20304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kloth C, Fischborn T, Preibsch H, Schmehl J. [Rare case of palmar disc dislocation after wrist distorsion]. Unfallchirurg 2019; 122:573-577. [PMID: 30767026 DOI: 10.1007/s00113-019-0613-0] [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: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was the elaboration of clinical symptoms and image findings in injuries of the wrist and ulnar-sided pain with accompanying damage to the articular disc and the triangular fibrocartilage complex (TFCC). MATERIAL AND METHODS This article reports about a 26-year-old male patient who presented to the department of surgery of this hospital after repeated falls onto the right wrist. Following the latest fall there was persistent wrist pain and limited movement, especially in supination. The physical examination showed pressure pain above the ulnocarpal complex; however, under forced pronation and supination no pain in the ulnocarpal complex could be triggered. RESULTS Due to the symptoms damage to the TFCC was suspected and a magnetic resonance imaging (MRI) examination of the wrist was carried out. A TFCC damage reaching as far as the dorsal radioulnar ligament involving the dorsal suspension was demarcated with dislocation and displacement of the disc. For further differentiation of the damaged structures arthrography was performed and contrast medium containing gadolinium was injected into the joint gap. The imaging showed avulsion of the dorsal triangular disc from the dorsal suspension with volar dislocation. Treatment was continued with an arthrotomy by the formation of an ulnar pedicled capsular flap, the luxated TFCC was repositioned, central frayed and torn parts were resected and smoothed. Finally, the TFCC was refixed with two 3/0 PDS U‑sutures. CONCLUSION Ulnar-sided wrist pain can be caused by a variety of clinical pathologies, so that often no diagnosis can be made based on clinical symptoms alone and an imaging method is required; however, for a clear assessment of the ligament or joint injuries an MRI is necessary. Particularly for the evaluation of the TFCC injuries MRI is a sensitive diagnostic method. In the decision making, especially when atypical injury patterns are present, an arthrography should be performed in addition to MRI to obtain the best possible information on the anatomical circumstances. KEY POINTS In cases of injuries of the wrist and ulnar-sided pain collateral damage to the articular disc and the TFCC should always be considered and excluded when appropriate. A dislocation of the disc at the wrist is a rare consequence of trauma but should be considered in the differential diagnosis. In cases of unclear MRI results and complex injuries of the wrist or unclear symptoms, MR arthrography can be helpful.
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Affiliation(s)
- Christopher Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Till Fischborn
- Klinik für Hand‑, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland
| | - Heike Preibsch
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Deutschland
| | - Jörg Schmehl
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Deutschland
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High-resolution flat panel CT versus 3-T MR arthrography of the wrist: initial results in vivo. Eur Radiol 2018; 29:3233-3240. [PMID: 30552480 DOI: 10.1007/s00330-018-5901-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to compare the diagnostic performance of direct C-arm flat panel computed tomography arthrography (FPCT-A) with direct magnetic resonance arthrography (MR-A) of the wrist in patients with clinically suspected pathologies. METHODS Forty-nine patients underwent tri-compartmental wrist arthrography. FPCT-A was acquired using a high-resolution acquisition mode, followed by a 3-T MR exam using a dedicated wrist coil. Image quality and artifacts of FPCT-A and MR-A were evaluated with regard to the depictability of anatomical structures. The time stamps for the different image acquisitions were recorded for workflow assessment. RESULTS Image quality was rated significantly superior for all structures for FPCT-A (p < 0.001) as compared to MR-A including intrinsic ligaments, TFCC, cartilage, subchondral bone, and trabeculae. The differences in image quality were highest for cartilage (2.0) and lowest for TFCC (0.9). The artifacts were rated lower in MR-A than in FPCT-A (p < 0.001). The procedure was more time-efficient in FPCT-A than in MR-A. CONCLUSIONS FPCT-A of the wrist provides superior image quality and optimized workflow as compared to MR-A. Therefore, FPCT-A should be considered in patients scheduled for dedicated imaging of the intrinsic structures of the wrist. KEY POINTS • FPCT arthrography allows high-resolution imaging of the intrinsic wrist structures. • The image quality is superior as compared to MR arthrography. • The procedure is more time-efficient than MR arthrography.
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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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Kootstra TJ, van Leeuwen WF, Chen N, Ring D. Variation in Repair of the Triangular Fibrocartilage Complex. J Wrist Surg 2018; 7:243-246. [PMID: 29922502 PMCID: PMC6005778 DOI: 10.1055/s-0038-1625953] [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] [Received: 10/10/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
Background There is controversy regarding the value of repair of the triangular fibrocartilage complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal radius fracture uncommonly benefits from repair, the role of repair in other settings is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon. Purpose The purpose of this study is to determine the rate of TFCC repair in patients who had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided wrist pain, and that showed signal changes in the TFCC. We tested the primary null hypothesis that there are no demographic or surgeon factors associated with repair of the TFCC. Patients and Methods Three hundred and ninety-four patients with ulnar-sided wrist pain and an MRI scan showing changes in the TFCC were included in this retrospective study. No patients had instability of the distal radioulnar joint (DRUJ) recorded in the medical record. Surgical repair of TFCC tears was used as the primary outcome during statistical analysis to identify factors associated with repair. Results Out of 394 (6%), 25 patients underwent TFCC repair. We found that 10% of the treating surgeons (4 out of 41) performed 80% of the procedures (20 out of 25). Patients who discerned a trauma prior to their symptoms and patients whose MRI showed signal changes primarily in the ulnar portion of the TFCC were more likely to have surgical repair. Conclusion We found that the rate of TFCC repair varies substantially from surgeon-to-surgeon. The observation that repair is more likely to happen when patients perceive themselves as injured suggests that perception of injury affects how patients and surgeons consider treatment options. To help avoid surgeries based on surgeon bias or patient misperception, we suggest studying the effect of tools that provide simple, balanced, dispassionate, and empowering information (e.g., decision aids) that can limit surgeon-to-surgeon variation. Level of Evidence Level IV.
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Affiliation(s)
- Thomas J.M. Kootstra
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wouter F. van Leeuwen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Takahashi T, Kimura M, Takeshita K. MRI evaluation of the ACL remnant tissue in ACL-deficient knee. J Orthop Surg (Hong Kong) 2018; 25:2309499017739479. [PMID: 29137565 DOI: 10.1177/2309499017739479] [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] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To clarify the relationship between anterior cruciate ligament (ACL) remnant tissue at the time of surgery and preoperative evaluation of ACL-injured knee. METHODS A total of 123 patients were enrolled and classified into four groups based on the classification of ACL remnant tissue. To quantify the signal-noise quotient (SNQ), five regions of interest (ROIs), such as tibial, mid, femoral ACL remnant, tendon of quadriceps femoris to normalize the signal intensity of ACL remnant tissue, and background measurements, were measured. Preoperative side-to-side difference (SSD) and SNQ were analyzed. RESULTS Significant differences were observed in preoperative SSD of the four groups ( p = 0.021), and a post hoc analysis revealed that SSD in Crain type 2 was significantly smaller than that in Crain type 4 ( p = 0.014). SSD in Crain type 3 was also significantly smaller than that in Crain type 4 ( p = 0.0030). There were significant differences in SNQ at the tibial, mid, and femoral portion in Crain types 2 and 3 ( p < 0.001); SNQ at the tibial portion in Crain type 2 was significantly lower than that at the mid portion ( p = 0.024); and SNQ at the tibial portion in Crain type 3 was significantly lower than that at the mid portion ( p = 0.016). Furthermore, significant differences were observed in SNQ at the tibial portions in the four groups ( p = 0.034), and SNQ at the tibial portions in Crain type 2 was significantly lower than that in Crain type 1 ( p = 0.044). Also, SNQ at the tibial portions in Crain type 3 was significantly lower than that in Crain type 1 ( P = 0.035). CONCLUSION The femoral attachment of the ACL remnant tissue may influence the SNQ of the tibial remnant tissue and the stability of the ACL-injured knee.
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Affiliation(s)
- Tsuneari Takahashi
- 1 Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan.,2 Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masashi Kimura
- 1 Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
| | - Katsushi Takeshita
- 2 Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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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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28
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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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Gornitzky AL, Lin IC, Carrigan RB. The Diagnostic Utility and Clinical Implications of Wrist MRI in the Pediatric Population. Hand (N Y) 2018; 13:143-149. [PMID: 28719991 PMCID: PMC5950963 DOI: 10.1177/1558944717695752] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unexplained wrist pain is a common presentation in children. To our knowledge, no studies have explored the clinical utility of magnetic resonance imaging (MRI) in the diagnostic workup of pediatric patients. METHODS We retrospectively reviewed 307 consecutive wrist MRIs ordered at a tertiary-care pediatric hospital. Demographic data and the indication for imaging were recorded and grouped into admitting categories. The final impression of each MRI was scored with regard to potential impact on future treatment (0 = normal, 1 = minimal, 2 = moderate, 3 = high). Patients who went on to wrist surgery within 1 year were noted. RESULTS In our cohort, 27% of all studies were normal, including 34% of those with pain. Although pain was the most common category, MRI was most useful in the delineation of a mass/cyst, evaluating for infection and evaluating arthropathy. Compared with all other categories, patients with pain were 3.6 times more likely to have a normal study and 4.6 times more likely to have a clinical score less than or equal to 1. Given an admitting diagnosis of pain, females were 1.7 times more likely to present for an MRI and 2.4 times more likely to have a normal MRI. The Spearman correlation revealed no linear relationship between age and MRI outcome. In all, 13% of patients went on to have surgery within 1 year of MRI. CONCLUSIONS At our pediatric institution, the majority of wrist MRIs were ordered for wrist pain. Given our data, wrist MRI is not an ideal screening tool in children, particularly in those with wrist pain, and should only be used to exclude or confirm a specific diagnosis.
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Affiliation(s)
| | - Ines C. Lin
- University of Pennsylvania, Philadelphia, USA
| | - Robert B. Carrigan
- Children’s Hospital of Philadelphia, PA, USA,Robert B. Carrigan, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Division of Orthopaedics, Philadelphia, PA 19104, USA.
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Wrist Arthroscopy in Children and Adolescent With Chronic Wrist Pain: Arthroscopic Findings Compared With MRI. J Pediatr Orthop 2017; 37:e321-e325. [PMID: 28594695 DOI: 10.1097/bpo.0000000000000887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Wrist arthroscopy is a dynamic diagnostic procedure and its indications are growing as a treatment modality in the adult population. The aim of the study was to retrospectively report our series of pediatric and adolescence with chronic wrist pain, with or without wrist instability who underwent wrist arthroscopy after failing at least 4 months of conservative management. Our secondary aim was to report the sensitivity and specificity of clinical examination and magnetic resonance imaging evaluation for various injury subgroups against the gold standard of the arthroscopic findings. Technical challenges, complications, and outcomes are also discussed. METHODS A retrospective review of the medical records of 32 pediatric and adolescent patients who underwent wrist arthroscopy was conducted. Preoperative clinical diagnosis, radiographic, and intraoperative findings including classifications of triangular fibrocartilage complex (TFCC) and interosseous ligaments were obtained. Patients were followed up to 1 year postoperatively and were discharged if symptom free. RESULTS Thirty-three wrist arthroscopies in 32 patients were performed from 1996 to 2004. There were 2 male and 30 female patients. At arthroscopy 16 wrists were found to have TFCC injuries, 11 wrists had scapholunate injuries, and 8 had lunotriquetral (LT) injuries. Clinical examination for diagnosis of TFCC injury was too sensitive and nonspecific; however, clinical diagnosis of scapholunate injury was sensitive and specific. LT injury was under diagnosed clinically. Magnetic resonance imaging was found to have a low sensitivity for diagnosis of LT injury but diagnosis of TFCC was sensitive and specific. CONCLUSIONS The sex ratio of 2 males:30 females was startling. Nevertheless, this therapeutic level 3 study supports a thorough search for pathology in any patient with persistent wrist symptoms because pathology was identified in 32 of the 33 wrists at arthroscopy. LEVEL OF EVIDENCE Level III-Therapeutic.
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Nozaki T, Rafijah G, Yang L, Ueno T, Horiuchi S, Hitt D, Yoshioka H. High-resolution 3 T MRI of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities using Palmer and Outerbridge classifications. Clin Radiol 2017; 72:904.e1-904.e10. [DOI: 10.1016/j.crad.2017.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022]
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Abstract
Determining the etiology of ulnar-sided wrist pain is often challenging. The condition may be acute or chronic, and differential diagnoses include injuries to the ulnar carpal bones, ligament tears, tendinitis, vascular conditions, osteoarthritis and systemic arthritis, and ulnar nerve compression. An anatomically based, methodical physical examination coupled with provocative maneuvers, including piano key, ulnar impaction, shuck, foveal stress, and extensor carpi ulnaris synergy tests, further defines the differential diagnosis. Diagnostic imaging used in the evaluation of ulnar-sided wrist pain includes plain radiographs and MRI with or without arthrography. Wrist arthroscopy is becoming increasingly important in the diagnosis and management of ulnar-sided intra-articular wrist pathology.
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Asaad AM, Andronic A, Newby MP, Harrison JWK. Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain. J Hand Surg Eur Vol 2017; 42:580-585. [PMID: 28488454 DOI: 10.1177/1753193417695180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We reviewed a series of 50 consecutive wrist arthroscopy patients who had been investigated pre-operatively by direct magnetic resonance arthrography and calculated the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of magnetic resonance arthrography in detecting full-thickness triangular fibrocartilage complex tears, intrinsic carpal ligamentous lesions, wrist synovitis and chondral lesions in the radiocarpal joint. The sensitivities of magnetic resonance arthrography in detecting central triangular fibrocartilage complex tears, peripheral triangular fibrocartilage complex tears, scapholunate ligament tears, lunotriquetral ligament tears, dorsal synovitis and radiocarpal chondral lesions were 89%, 63%, 71%, 100%, 32% and 65%, respectively, and its specificities in detecting these lesions were 91%, 98%, 89%, 94% 94% and 97%, respectively. This study suggests that single compartment direct wrist magnetic resonance arthrography can provide high diagnostic accuracy for full-thickness triangular fibrocartilage lesions, intrinsic carpal ligament tears and chondral lesions in the radiocarpal joint, but that it is much less accurate in diagnosing synovitis of the radiocarpal joint. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A M Asaad
- Queen Elizabeth Hospital, Gateshead, UK
| | | | - M P Newby
- Queen Elizabeth Hospital, Gateshead, UK
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34
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Abstract
The first imaging modality in patients suspected of distal radioulnar joint pathology should be conventional radiography to exclude or diagnose wrist pathology including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, (healed) fractures, or impaction syndromes. When conventional radiography is inconclusive, high resolution 3 Tesla magnetic resonance imaging is advised. We provide a broad overview of the literature regarding the use of intra-articular contrast both with computed tomography (CTA) or magnetic resonance imaging (MRA). Conventional arthrography and unenhanced computed tomography are not indicated. This article discusses the most useful imaging techniques in terms of clinical indications, patient positioning, technical imaging requirements, and diagnostic performance in patients with suspected distal radioulnar joint pathology. Furthermore, the most prevalent pathologies are discussed, with the focus on imaging characteristics in both stable and unstable distal radioulnar joints.
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Affiliation(s)
- S Jens
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - T Luijkx
- 2 Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - F F Smithuis
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Maas
- 1 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Werncke T, Sonnow L, Meyer BC, Lüpke M, Hinrichs J, Wacker FK, von Falck C. Ultra-high resolution C-Arm CT arthrography of the wrist: Radiation dose and image quality compared to conventional multidetector computed tomography. Eur J Radiol 2017; 89:191-199. [PMID: 28267538 DOI: 10.1016/j.ejrad.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/16/2017] [Accepted: 02/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective of this phantom and cadaveric study was to compare the effective radiation dose (ED) and image quality (IQ) between C-arm computed tomography (CACT) using an ultra-high resolution 1×1 binning with a standard 16-slice CT (MDCT) arthrography of the wrist. METHODS ED was determined with thermoluminescence dosimetry using an anthropomorphic phantom and different patient positions. Imaging was conducted in 10 human cadaveric wrists after tri-compartmental injection of diluted iodinated contrast material and a wire phantom. IQ of MDCT was compared with CACT reconstructed with a soft (CACT1) and sharp (CACT2) kernel. High and low contrast resolution was determined. Three radiologists assessed IQ of wrist structures and occurrence of image artifacts using a 5-point Likert scale. RESULTS ED of MDCT was comparable to standard CACT (4.3μSv/3.7μSv). High contrast resolution was best for CACT2, decreased to CACT1 and MDCT. Low contrast resolution increased between CACT2 and MDCT (P<0.001). IQ was best for CACT2 (1.3±0.5), decreased to CACT1 (1.9±0.6) and MDCT (3.5±0.6). Non-compromising artifacts were only reported for CACT. CONCLUSIONS The results of this phantom and cadaveric study indicate that ultra-high resolution C-Arm CT arthrography of the wrist bears the potential to outperform MDCT arthrography in terms of image quality and workflow at the cost of mildly increasing image artifacts while radiation dose to the patient is comparably low for both, MDCT and C-Arm CT.
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Affiliation(s)
- Thomas Werncke
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Lena Sonnow
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bernhard C Meyer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Matthias Lüpke
- University of Veterinary Medicine Hannover, Institute for General Radiology and Medical Physics, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Jan Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Frank K Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian von Falck
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients. Scand J Surg 2016; 106:173-179. [DOI: 10.1177/1457496916659226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. Materials and Methods: Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. Results: For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. Conclusion: Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in evaluating patients with wrist pain.
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Schmauss D, Pöhlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K. Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 2016; 136:873-80. [PMID: 26969464 DOI: 10.1007/s00402-016-2441-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The diagnostic value of clinical tests and magnetic resonance (MR) imaging for the investigation of triangular fibrocartilaginous complex (TFCC) lesions is not clear due to a lack of clinical data. MATERIALS AND METHODS We retrospectively analyzed 908 patients who underwent clinical tests and arthroscopy for suspected TFCC lesions at our institution. Further, MR imaging findings concerning the TFCC were gathered. We correlated clinical tests and MR imaging findings with those obtained during arthroscopy, and we calculated sensitivity, specificity, as well as positive and negative predictive values. RESULTS In the whole cohort, the positive predictive values of all clinical tests were low, ranging from 0.53 to 0.55. The ulna grinding test had the highest sensitivity, but lowest specificity. Sensitivity and specificity of the ulnar fovea sign and magnetic resonance imaging were similar, ranging from 0.73 to 0.76, and from 0.41 to 0.44, respectively. To some degree, the diagnostic value seemed to depend on the Palmer class of TFCC lesion. CONCLUSIONS According to this study, clinical tests and MR imaging findings are of very limited diagnostic value for the diagnosis of TFCC lesions.
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Affiliation(s)
- D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - S Pöhlmann
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany
| | - J A Lohmeyer
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - G Germann
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany.,Clinic for Plastic, Reconstructive and Aesthetic Surgery, ETHIANUM, Heidelberg, Germany
| | - B Bickert
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. .,Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany.
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Barlow SJ. A Non-surgical Intervention for Triangular Fibrocartilage Complex Tears. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 21:271-276. [DOI: 10.1002/pri.1672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/09/2015] [Accepted: 02/28/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Susan J. Barlow
- Department of Physical Therapy; The University of Tennessee at Chattanooga; Chattanooga TN 37403 USA
- Siskin Hospital for Physical Rehabilitation; 1 Siskin Plaza Chattanooga TN 37403 USA
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Wang ZX, Chen SL, Wang QQ, Liu B, Zhu J, Shen J. The performance of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury: a meta-analysis. J Hand Surg Eur Vol 2015; 40:477-84. [PMID: 25600854 DOI: 10.1177/1753193414567425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate the accuracy of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury through a meta-analysis. A comprehensive literature search was conducted before 1 April 2014. All studies comparing magnetic resonance imaging results with arthroscopy or open surgery findings were reviewed, and 25 studies that satisfied the eligibility criteria were included. Data were pooled to yield pooled sensitivity and specificity, which were respectively 0.83 and 0.82. In detection of central and peripheral tears, magnetic resonance imaging had respectively a pooled sensitivity of 0.90 and 0.88 and a pooled specificity of 0.97 and 0.97. Six high-quality studies using Ringler's recommended magnetic resonance imaging parameters were selected for analysis to determine whether optimal imaging protocols yielded better results. The pooled sensitivity and specificity of these six studies were 0.92 and 0.82, respectively. The overall accuracy of magnetic resonance imaging was acceptable. For peripheral tears, the pooled data showed a relatively high accuracy. Magnetic resonance imaging with appropriate parameters are an ideal method for diagnosing different types of triangular fibrocartilage complex tears.
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Affiliation(s)
- Z X Wang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - S L Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Q Q Wang
- Research Institute of Orthopedics, Beijing Ji Shui Tan Hospital, Beijing, China
| | - B Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - J Zhu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - J Shen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Coert JH, Hoogvliet P, Rinkel WD. Hand examination and investigations. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Moritomo H, Arimitsu S, Kubo N, Masatomi T, Yukioka M. Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2015; 40:245-51. [PMID: 25542437 DOI: 10.1016/j.jhsa.2014.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To classify triangular fibrocartilage complex (TFCC) foveal lesions on the basis of computed tomography (CT) arthrography using a radial plane view and to correlate the CT arthrography results with surgical findings. We also tested the interobserver and intra-observer reliability of the radial plane view. METHODS A total of 33 patients with a suspected TFCC foveal tear who had undergone wrist CT arthrography and subsequent surgical exploration were enrolled. We classified the configurations of TFCC foveal lesions into 5 types on the basis of CT arthrography with the radial plane view in which the image slices rotate clockwise centered on the ulnar styloid process. Sensitivity, specificity, and positive predictive values were calculated for each type of foveal lesion in CT arthrography to detect foveal tears. We determined interobserver and intra-observer agreements using kappa statistics. We also compared accuracies with the radial plane views with those with the coronal plane views. RESULTS Among the tear types on CT arthrography, type 3, a roundish defect at the fovea, and type 4, a large defect at the overall ulnar insertion, had high specificity and positive predictive value for the detection of foveal tears. Specificity and positive predictive values were 90% and 89% for type 3 and 100% and 100% for type 4, respectively, whereas sensitivity was 35% for type 3 and 22% for type 4. Interobserver and intra-observer agreement was substantial and almost perfect, respectively. The radial plane view identified foveal lesion of each palmar and dorsal radioulnar ligament separately, but accuracy results with the radial plane views were not statistically different from those with the coronal plane views. CONCLUSIONS Computed tomography arthrography with a radial plane view exhibited enhanced specificity and positive predictive value when a type 3 or 4 lesion was identified in the detection of a TFCC foveal tear compared with historical controls. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Hisao Moritomo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
| | - Sayuri Arimitsu
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Nobuyuki Kubo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takashi Masatomi
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Masao Yukioka
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
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Ross C, Hoffstetter P, Fellner C, Herold T, Nerlich M, Huber MKI. [Detection of intrinsic ligament and TFCC lesions of the wrist. Direct versus indirect MRI arthrography]. Unfallchirurg 2014; 118:251-5. [PMID: 25294560 DOI: 10.1007/s00113-014-2662-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to validate the diagnostic value of direct magnetic resonance imaging (dMRI) arthrography and indirect MRI (iMRI) arthrography concerning intrinsic ligament injuries and tears of the triangular fibrocartilage complex (TFCC). PATIENTS AND METHODS A randomized prospective trial was conducted with patients who presented with wrist pain potentially due to carpal lesions and 10 patients aged 19-60 years (3 female and 7 male) were included. Between the clinical examination and the diagnostic and therapeutic arthroscopy, dMRI and iMRI arthrography were performed for the diagnostics of injuries of the intrinsic ligaments or the TFCC. The results of dMRI and iMRI arthrography were evaluated by two radiologists blinded to the injuries of the patients and a consensus was reached. The results were compared with the findings obtained by arthroscopy. RESULTS In the arthroscopy five lesions of the scapholunate ligament (SL), one of the lunotriquetral ligament (LT) and seven of the TFCC were identified. The sensitivity of iMRI and dMRI for carpal ligament lesions (SL and LT) was low (50 %) whereas the specificity was high (93 %). For injuries of the TFCC the sensitivity (up to 100 %) and the specificity (100 %) were both excellent. The area under the curve (AUC) in the receiver operating characteristics (ROC) analysis was high for TFCC lesions in both dMRI and iMRI arthrography. CONCLUSION Indirect MRI arthrography is a suitable method for detection of injuries of the TFCC and intrinsic ligaments of the wrist with good sensitivity and specificity. Despite the low number of patients the results of this study showed that there were no essential differences between dMRI and iMRI arthrography with respect to the diagnostic value for carpal injuries of the wrist.
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Affiliation(s)
- C Ross
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Kümmel A, Ebner L, Kraus M, Mauch F, Geyer T, Mentzel M, Gülke J. Magnetresonanztomographie bei häufigen Verletzungen des Handgelenks. Unfallchirurg 2014; 117:221-6. [DOI: 10.1007/s00113-013-2403-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ochodo EA, van Enst WA, Naaktgeboren CA, de Groot JAH, Hooft L, Moons KGM, Reitsma JB, Bossuyt PM, Leeflang MMG. Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews: a cross-sectional study. BMC Med Res Methodol 2014; 14:33. [PMID: 24588874 PMCID: PMC3942773 DOI: 10.1186/1471-2288-14-33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/21/2014] [Indexed: 01/08/2023] Open
Abstract
Background Drawing conclusions from systematic reviews of test accuracy studies without considering the methodological quality (risk of bias) of included studies may lead to unwarranted optimism about the value of the test(s) under study. We sought to identify to what extent the results of quality assessment of included studies are incorporated in the conclusions of diagnostic accuracy reviews. Methods We searched MEDLINE and EMBASE for test accuracy reviews published between May and September 2012. We examined the abstracts and main texts of these reviews to see whether and how the results of quality assessment were linked to the accuracy estimates when drawing conclusions. Results We included 65 reviews of which 53 contained a meta-analysis. Sixty articles (92%) had formally assessed the methodological quality of included studies, most often using the original QUADAS tool (n = 44, 68%). Quality assessment was mentioned in 28 abstracts (43%); with a majority (n = 21) mentioning it in the methods section. In only 5 abstracts (8%) were results of quality assessment incorporated in the conclusions. Thirteen reviews (20%) presented results of quality assessment in the main text only, without further discussion. Forty-seven reviews (72%) discussed results of quality assessment; the most frequent form was as limitations in assessing quality (n = 28). Only 6 reviews (9%) further linked the results of quality assessment to their conclusions, 3 of which did not conduct a meta-analysis due to limitations in the quality of included studies. In the reviews with a meta-analysis, 19 (36%) incorporated quality in the analysis. Eight reported significant effects of quality on the pooled estimates; in none of them these effects were factored in the conclusions. Conclusion While almost all recent diagnostic accuracy reviews evaluate the quality of included studies, very few consider results of quality assessment when drawing conclusions. The practice of reporting systematic reviews of test accuracy should improve if readers not only want to be informed about the limitations in the available evidence, but also on the associated implications for the performance of the evaluated tests.
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Affiliation(s)
- Eleanor A Ochodo
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Abstract
In isolation, distal ulna fractures are rare. They are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radioulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Fixation of distal ulna fractures can be problematic owing to comminution making reduction challenging. A thin soft tissue can lead to hardware prominence and necessitate implant removal. In this Current Concepts article, we review the anatomy, pathology, and treatment of distal ulna fractures as well as potential complications and salvage procedures.
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Affiliation(s)
- Todd A Richards
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - D Nicole Deal
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia.
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Comment on "3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears", Cerny M et al. Eur J Radiol (2013). Eur J Radiol 2013; 82:e909. [PMID: 24016831 DOI: 10.1016/j.ejrad.2013.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/13/2013] [Indexed: 11/20/2022]
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