title: Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging.
abstract: OBJECTIVE
  To compare indirect magnetic resonance (MR) arthrography with unenhanced MR imaging of the wrist for evaluation of the central disk of the triangular fibrocartilage complex (TFCC) and the scapholunate and lunotriquetral interosseous ligaments.
  
  
  METHODS
  Eighty-six wrists were evaluated at MR imaging (41 indirect MR arthrography and 45 unenhanced MR imaging examinations). Three musculoskeletal radiologists independently evaluated the central disk of the TFCC and scapholunate and lunotriquetral ligaments and compared the results with those of wrist arthroscopy. Sensitivity and specificity were calculated for each of the readers, and the means were obtained. Sensitivities and specificities were compared with the Student t test.
  
  
  RESULTS
  Thirty-three tears of the central disk of the TFCC and 13 scapholunate and 18 lunotriquetral ligament tears were identified at arthroscopy. Sensitivities and specificities were 54%-73% and 83%-91%, respectively, in the evaluation of the central disk of the TFCC, with no significant difference between indirect MR arthrography (P =.666) and unenhanced MR imaging (P =.559). Sensitivities and specificities in the evaluation of the scapholunate ligament were 38%-69% and 75%-99%, respectively, with a significant improvement in sensitivity at indirect MR arthrography (P =.017) and no significant difference in specificity (P =.876). Sensitivities in the evaluation of the lunotriquetral ligament were poor, 0%-22%, though the specificities were 88%-99%, with no significant difference between indirect MR arthrography and unenhanced MR imaging (P =.592 and P =.354, respectively, for sensitivity and specificity.
  
  
  CONCLUSIONS
  Indirect MR arthrography significantly improves sensitivity in the evaluation of the scapholunate ligament when compared with unenhanced MR imaging of the wrist but does not significantly improve the ability to evaluate the central disk of the TFCC or the lunotriquetral ligament.
authors.affiliation: Department of Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA. andrew.haims@yale.edu
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 C
authors.initials: RC
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: D000328:Adult; D002348:Carpal Bones / Q000293:injuries; D002358:Cartilage, Articular / Q000293:injuries; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012680:Sensitivity and Specificity; D014954:Wrist Injuries / Q000175:diagnosis*; D014955:Wrist Joint / Q000473:pathology*