Limits...
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

Flowchart depicting treatment algorithm for wrist ligament injuries at our institute (stability of injuries is assessed on clinical examination, radiographs, and MRI; *unstable injury = visible deformity on radiographs; **dynamically unstable injury = instability elicited by stress views or fluoroscopy; ***stable injury = ligamentous injury without instability/deformity on stress views or at rest)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4126141&req=5

Figure 6: Flowchart depicting treatment algorithm for wrist ligament injuries at our institute (stability of injuries is assessed on clinical examination, radiographs, and MRI; *unstable injury = visible deformity on radiographs; **dynamically unstable injury = instability elicited by stress views or fluoroscopy; ***stable injury = ligamentous injury without instability/deformity on stress views or at rest)

Mentions: A broad outline of the protocol followed at our institute for management of wrist ligament injuries is depicted in Figure 6. As previously mentioned, only patients with MRI evidence of a ligament tear and fulfilling certain clinical criteria were taken up for surgical procedures. Patient with normal MRI findings were not taken up for surgery to avoid unnecessary invasive procedures. Many patients with chronic ligament tears responded well to conservative management (analgesics, immobilization with a supportive cast). Arthroscopic debridement resulted in symptomatic improvement in patients who did not respond to conservative measures [Figure 4]. Ligament repair using arthroscopic or open surgical techniques (using bone anchoring sutures, pinning with K-wires) was performed in patients who presented with fractures or SLL tears [Figure 2]. Surgical repair restored full range of motion and provided pain relief as well in these patients. Reconstructive procedures for chronic injury are not performed at our institute.


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)

Flowchart depicting treatment algorithm for wrist ligament injuries at our institute (stability of injuries is assessed on clinical examination, radiographs, and MRI; *unstable injury = visible deformity on radiographs; **dynamically unstable injury = instability elicited by stress views or fluoroscopy; ***stable injury = ligamentous injury without instability/deformity on stress views or at rest)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Flowchart depicting treatment algorithm for wrist ligament injuries at our institute (stability of injuries is assessed on clinical examination, radiographs, and MRI; *unstable injury = visible deformity on radiographs; **dynamically unstable injury = instability elicited by stress views or fluoroscopy; ***stable injury = ligamentous injury without instability/deformity on stress views or at rest)
Mentions: A broad outline of the protocol followed at our institute for management of wrist ligament injuries is depicted in Figure 6. As previously mentioned, only patients with MRI evidence of a ligament tear and fulfilling certain clinical criteria were taken up for surgical procedures. Patient with normal MRI findings were not taken up for surgery to avoid unnecessary invasive procedures. Many patients with chronic ligament tears responded well to conservative management (analgesics, immobilization with a supportive cast). Arthroscopic debridement resulted in symptomatic improvement in patients who did not respond to conservative measures [Figure 4]. Ligament repair using arthroscopic or open surgical techniques (using bone anchoring sutures, pinning with K-wires) was performed in patients who presented with fractures or SLL tears [Figure 2]. Surgical repair restored full range of motion and provided pain relief as well in these patients. Reconstructive procedures for chronic injury are not performed at our institute.

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