title: Noncontrast MR imaging and MR arthrography of the ulnar collateral ligament of the elbow: prospective evaluation of two-dimensional pulse sequences for detection of complete tears.
abstract: OBJECTIVE
  To compare MR imaging techniques with differing contrast and spatial resolution for evaluation of complete disruption of the ulnar collateral ligament (UCL) anterior bundle in a cadaveric elbow model.
  
  
  METHODS
  Complete UCL tears were surgically created at the typical location for clinical tears in eight of 28 fresh frozen cadaveric elbow specimens. All specimens underwent 1.5 T MR imaging in the oblique coronal plane, using an extremity coil. The sequences employed were: T1-weighted spin echo (T1 SE), proton density-weighted (PD) fast spin echo (FSE), fat-suppressed T2-weighted FSE (T2 FSE), gradient recalled echo (GRE) with a high matrix, PD FSE with a high matrix (HRPD), and fat suppressed T1-weighted SE with intra-articular gadolinium (MRAr). Two radiologists independently graded the UCL with separate and side-by-side assessments.
  
  
  RESULTS
  Sensitivity/specificity pairs were as follows for reader A and reader B, respectively: T1 SE: 0.25/0.95, 0.50/0.95; PD FSE: 0.38/1.00, 0.25/1.00; T2 FSE: 0.50/0.95, 0.63/0.95; GRE: 0.63/0.85, 0.63/0.60; MRAr: 0.88/1.00, 1.00/0.80; HRPD: 0.50/1.00, 0.88/0.80. Kappa statistics for measuring interobserver reliability for each sequence were poor under T1 SE (-0.13) and GRE (0.19), moderate under HRPD (0.41) and T2 FSE (0.44) and good under MRAr (0.62) and PD FSE (0.78). For both readers, the rating for overall image quality was highest for HRPD, and the rating for UCL lesion conspicuity was the highest for MRAr.
  
  
  CONCLUSIONS
  Of the MR imaging pulse sequences tested, MRAr showed the greatest ability to identify complete ligamentous injuries with good agreement between readers and had the highest subjective preference for lesion conspicuity. However, HRPD had the least interobserver variability and the highest subjective preference for overall image quality.
authors.affiliation: Jefferson Medical College, Thomas Jefferson University Hospital, Department of Radiology, 111 South 11th Street, Suite 3390, Philadelphia, PA 19107-5091, USA. john.carrino@mail.tju.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Carrino
authors.forename: W B
authors.initials: WB
authors.lastname: Morrison
authors.forename: K H
authors.initials: KH
authors.lastname: Zou
authors.forename: R T
authors.initials: RT
authors.lastname: Steffen
authors.forename: W N
authors.initials: WN
authors.lastname: Snearly
authors.forename: P M
authors.initials: PM
authors.lastname: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography / Q000379:methods*; D017885:Collateral Ligaments / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage; D004551:Elbow Joint / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014457:Ulna / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA