[Indirect MR Arthrography of the wrist in the diagnosis of TFCC-Lesions].
OBJECTIVE
The objective of this prospective study was to assess the value of the indirect MR arthrography (MR-AR) of the wrist in the detection of lesions of the TFCC.


METHODS
Indirect MR-AR was performed in 45 patients (23 f/22 m) with unclear ulnar wrist pain. After i. v. injection of 0.1 mmol/kg Gd-DTPA and after a motion-phase of the wrist (15 minutes) MRI was performed in a coronal plane. We used a STIR-, a fatsaturated (fs) T1-SE and a 3D-DESS sequence. The images were evaluated by two radiologists using a consensus score. The lesions were assigned to the system of Palmer and correlated with arthroscopy.


RESULTS
Indirect MR-AR showed in 35 of 45 patients a lesion of the TFCC, but arthroscopy only revealed a defect in 32 cases. This means three false positive but no false negative assessments by MRI. Using this MRI protocol sensitivity and specificity in the detection of TFCC lesions were calculated as 100 % and 77 %. The accuracy was 93 %. Small degenerative changes of the fibres were most common (Palmer type II A). In trauma patients the ligaments usually showed tears near the insertion at the ulna (Palmer type I B). The sensitivity and specificity was 88 % and 95 % for evaluation of the scapho-lunate (SL) ligament, the accuracy was 93 %. Arthroscopy and MRI did not diagnose any rupture of the lunate-triquetral (LT) ligament.


CONCLUSIONS
Indirect MR-AR is a non-invasive method with a high sensitivity in the evaluation of the TFCC and associated injuries. Therefore, it is an excellent screening procedure to assess the indication for therapeutic arthroscopy.
Herold
T
T
Institut für Röntgendiagnostik, Klinikum der Universität Regensburg. thomas.herold@klinik.uni-regensburg.de
Lenhart
M
M
Held
P
P
Babel
M
M
Ruf
S
S
Feuerbach
S
S
Link
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014954:Wrist Injuries / Q000175:diagnosis*; D014955:Wrist Joint
D003287:Contrast Media; D019786:Gadolinium DTPA