Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist.
OBJECTIVE
The treatment of peripheral tears of the triangular fibrocartilage complex is radically different from the more typical central, degenerative tears. To our knowledge, no reports in the imaging literature specifically evaluate tears of the ulnar attachment of the triangular fibrocartilage complex. We evaluated the accuracy of MR imaging in these patients.


METHODS
Eighty-six MR imaging examinations of the wrist (41 indirect MR arthrograms and 45 unenhanced MR images) were evaluated: 20 wrists with surgically confirmed peripheral triangular fibrocartilage complex tears and 66 wrists with surgically documented normal ulnar attachment. These cases were evaluated by three experienced musculoskeletal radiologists, who were unaware of the surgical findings, to assess the presence of peripheral triangular fibrocartilage complex tears or fluid signal at the ulnar attachment of the triangular fibrocartilage complex.


RESULTS
The sensitivity for evaluation of the peripheral triangular fibrocartilage complex tear was 17%, with a specificity of 79% and an accuracy of 64%. High signal intensity at the ulnar insertion of the triangular fibrocartilage complex as a marker for tear showed a sensitivity of 42%, a specificity of 63%, and an accuracy of 55%. Weighted kappa values revealed only fair agreement among the three observers.


CONCLUSIONS
MR imaging does not adequately reveal the peripheral attachment of the triangular fibrocartilage complex.
Haims
Andrew H
AH
Department of Radiology, Yale University School of Medicine, 333 Cedar St., P. O. Box 208042, New Haven, CT 06520-8042, USA.
Schweitzer
Mark E
ME
Morrison
William B
WB
Deely
Diane
D
Lange
Robert
R
Osterman
A Lee
AL
Bednar
John M
JM
Taras
John S
JS
Culp
Randall W
RW
D000293:Adolescent; D000328:Adult; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014954:Wrist Injuries / Q000473:pathology*