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Comparison of conventional MRI and MR arthrography in the evaluation wrist ligament tears: A preliminary experience.

Pahwa S, Srivastava DN, Sharma R, Gamanagatti S, Kotwal PP, Sharma V - Indian J Radiol Imaging (2014)

Bottom Line: One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography.The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively.MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Aims: To compare conventional magnetic resonance imaging (MRI) and direct magnetic resonance (MR) arthrography in the evaluation of triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament tears.

Materials and methods: T1-weighted, fat suppressed (FS) proton density plus T2-weighted (FS PD/T2), 3D multiple-echo data image combination (MEDIC) sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL) and lunatotriquetral ligament (LTL) tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard).

Results: SIXTEEN PATIENTS UNDERWENT ARTHROSCOPY/OPEN SURGERY: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively.

Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

No MeSH data available.


Related in: MedlinePlus

TFC and lunatotriquetral ligament tears in a 28 year old male patient. Coronal PD image (A) shows a central TFC tear (arrow) with doubtful tears of scapholunate and lunatotriquetral ligaments. Apart from the TFC tear (bold arrow), a defect in the lunatotriquetral ligament is outlined by gadolinium in coronal MR arthrogram image (B) with contrast extending into the midcarpal joint (arrow); the scapholunate ligament is confirmed to be intact (open arrow). Both the tears were arthroscopically confirmed
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Figure 4: TFC and lunatotriquetral ligament tears in a 28 year old male patient. Coronal PD image (A) shows a central TFC tear (arrow) with doubtful tears of scapholunate and lunatotriquetral ligaments. Apart from the TFC tear (bold arrow), a defect in the lunatotriquetral ligament is outlined by gadolinium in coronal MR arthrogram image (B) with contrast extending into the midcarpal joint (arrow); the scapholunate ligament is confirmed to be intact (open arrow). Both the tears were arthroscopically confirmed

Mentions: Lunatotriquetral ligament tears were diagnosed in 11 (21.4%) patients. Five LTL tears were found in 16 patients who underwent arthroscopy with or without open surgery [Figure 5] and statistical analysis was done for these patients. MR arthrography detected all five tears, two tears were diagnosed on MEDIC, and only one tear was visualized on FS PD/T2 sequence [Figures 4 and 5]. FS PD/T2 sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 20%, 100%, 100%, 73.3%, and 75%, respectively, for detecting LTL tears. MEDIC sequence had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 40%, 100%, 100%, 72.7%, and 81.3%, respectively, and MR arthrography had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 100%, 100%, 100%, and 100%, respectively.


Comparison of conventional MRI and MR arthrography in the evaluation wrist ligament tears: A preliminary experience.

Pahwa S, Srivastava DN, Sharma R, Gamanagatti S, Kotwal PP, Sharma V - Indian J Radiol Imaging (2014)

TFC and lunatotriquetral ligament tears in a 28 year old male patient. Coronal PD image (A) shows a central TFC tear (arrow) with doubtful tears of scapholunate and lunatotriquetral ligaments. Apart from the TFC tear (bold arrow), a defect in the lunatotriquetral ligament is outlined by gadolinium in coronal MR arthrogram image (B) with contrast extending into the midcarpal joint (arrow); the scapholunate ligament is confirmed to be intact (open arrow). Both the tears were arthroscopically confirmed
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126141&req=5

Figure 4: TFC and lunatotriquetral ligament tears in a 28 year old male patient. Coronal PD image (A) shows a central TFC tear (arrow) with doubtful tears of scapholunate and lunatotriquetral ligaments. Apart from the TFC tear (bold arrow), a defect in the lunatotriquetral ligament is outlined by gadolinium in coronal MR arthrogram image (B) with contrast extending into the midcarpal joint (arrow); the scapholunate ligament is confirmed to be intact (open arrow). Both the tears were arthroscopically confirmed
Mentions: Lunatotriquetral ligament tears were diagnosed in 11 (21.4%) patients. Five LTL tears were found in 16 patients who underwent arthroscopy with or without open surgery [Figure 5] and statistical analysis was done for these patients. MR arthrography detected all five tears, two tears were diagnosed on MEDIC, and only one tear was visualized on FS PD/T2 sequence [Figures 4 and 5]. FS PD/T2 sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 20%, 100%, 100%, 73.3%, and 75%, respectively, for detecting LTL tears. MEDIC sequence had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 40%, 100%, 100%, 72.7%, and 81.3%, respectively, and MR arthrography had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 100%, 100%, 100%, and 100%, respectively.

Bottom Line: One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography.The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively.MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Aims: To compare conventional magnetic resonance imaging (MRI) and direct magnetic resonance (MR) arthrography in the evaluation of triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament tears.

Materials and methods: T1-weighted, fat suppressed (FS) proton density plus T2-weighted (FS PD/T2), 3D multiple-echo data image combination (MEDIC) sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL) and lunatotriquetral ligament (LTL) tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard).

Results: SIXTEEN PATIENTS UNDERWENT ARTHROSCOPY/OPEN SURGERY: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively.

Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

No MeSH data available.


Related in: MedlinePlus