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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

Scapholunate and lunatotriquetral ligament tears in a 30 year old woman with wrist pain since 1 year. A defect is seen in the scapholunate ligament (bold arrow); TFC and the lunatotriquetral ligament (thin arrow) are apparently intact on coronal MEDIC image (A). However, coronal MR arthrogram image (B) shows a radial tear of TFC (open arrow) and a tear of the lunate attachment of lunatotriquetral ligament (thin arrow), with contrast extending into the gap and reaching into the midcarpal joint; scapholunate ligament tear is also well visualized (bold arrow). All the tears were confirmed on arthroscopy
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Figure 5: Scapholunate and lunatotriquetral ligament tears in a 30 year old woman with wrist pain since 1 year. A defect is seen in the scapholunate ligament (bold arrow); TFC and the lunatotriquetral ligament (thin arrow) are apparently intact on coronal MEDIC image (A). However, coronal MR arthrogram image (B) shows a radial tear of TFC (open arrow) and a tear of the lunate attachment of lunatotriquetral ligament (thin arrow), with contrast extending into the gap and reaching into the midcarpal joint; scapholunate ligament tear is also well visualized (bold arrow). All the tears were confirmed on arthroscopy

Mentions: Triangular Fibrocartilage Complex tears were diagnosed in 24 (45.3%) patients. Twelve full-thickness TFC tears were found in 16 patients who underwent arthroscopy/open surgery, out of which 9 tears were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography; statistical analysis was performed for these 16 patients [Figures 1–5]. We did not encounter any partial-thickness tears in our study. FS PD/T2 sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 75%, 100%, 90%, 50%, and 75%, respectively, for the detection of TFC tears, while MEDIC sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 83.3%, 100%, 90.9%, 60%, and 81.25%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography were 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)

Scapholunate and lunatotriquetral ligament tears in a 30 year old woman with wrist pain since 1 year. A defect is seen in the scapholunate ligament (bold arrow); TFC and the lunatotriquetral ligament (thin arrow) are apparently intact on coronal MEDIC image (A). However, coronal MR arthrogram image (B) shows a radial tear of TFC (open arrow) and a tear of the lunate attachment of lunatotriquetral ligament (thin arrow), with contrast extending into the gap and reaching into the midcarpal joint; scapholunate ligament tear is also well visualized (bold arrow). All the tears were confirmed on arthroscopy
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Scapholunate and lunatotriquetral ligament tears in a 30 year old woman with wrist pain since 1 year. A defect is seen in the scapholunate ligament (bold arrow); TFC and the lunatotriquetral ligament (thin arrow) are apparently intact on coronal MEDIC image (A). However, coronal MR arthrogram image (B) shows a radial tear of TFC (open arrow) and a tear of the lunate attachment of lunatotriquetral ligament (thin arrow), with contrast extending into the gap and reaching into the midcarpal joint; scapholunate ligament tear is also well visualized (bold arrow). All the tears were confirmed on arthroscopy
Mentions: Triangular Fibrocartilage Complex tears were diagnosed in 24 (45.3%) patients. Twelve full-thickness TFC tears were found in 16 patients who underwent arthroscopy/open surgery, out of which 9 tears were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography; statistical analysis was performed for these 16 patients [Figures 1–5]. We did not encounter any partial-thickness tears in our study. FS PD/T2 sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 75%, 100%, 90%, 50%, and 75%, respectively, for the detection of TFC tears, while MEDIC sequence showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 83.3%, 100%, 90.9%, 60%, and 81.25%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography were 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