title: Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist.
abstract: 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.
authors.affiliation: Department of Radiology, Yale University School of Medicine, 333 Cedar St., P. O. Box 208042, New Haven, CT 06520-8042, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Haims
authors.forename: Mark E
authors.initials: ME
authors.lastname: Schweitzer
authors.forename: William B
authors.initials: WB
authors.lastname: Morrison
authors.forename: Diane
authors.initials: D
authors.lastname: Deely
authors.forename: Robert
authors.initials: R
authors.lastname: Lange
authors.forename: A Lee
authors.initials: AL
authors.lastname: Osterman
authors.forename: John M
authors.initials: JM
authors.lastname: Bednar
authors.forename: John S
authors.initials: JS
authors.lastname: Taras
authors.forename: Randall W
authors.initials: RW
authors.lastname: Culp
mesh_terms: 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*