Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint.
OBJECTIVE
Although central tears of the triangular fibrocartilage are easily seen on imaging, peripheral tears of the ulnar attachment are frequently missed. The aim of this study was to evaluate the accuracy of MR arthrography of the distal radioulnar joint in depiction of peripheral tears of the triangular fibrocartilage.


METHODS
Forty-one patients (18 women, 23 men; mean age, 38 years; age range, 18-60 years) underwent MR arthrography and wrist arthroscopy. For MR arthrography, iopamidol (300 mg I/mL) and gadopentetate dimeglumine (4 mmol/L) were injected into the distal radioulnar joint. Consensus review of both MR arthrograms and conventional arthrograms was performed by two experienced musculoskeletal radiologists. Presence or absence of communicating and noncommunicating tears of the ulnar attachment of the triangular fibrocartilage was recorded. Arthroscopy was used as the standard of reference for determining sensitivity, specificity, and accuracy in detection of tears of the ulnar attachment.


RESULTS
At MR arthrography, communicating tear of the ulnar attachment was diagnosed in three patients, noncommunicating tear in 19 patients, and normal attachment in 19 patients. Arthroscopy revealed peripheral tear of the triangular fibrocartilage in all three patients with communicating tear, in 14 of 19 patients with noncommunicating tear, and in three of 19 patients with normal attachment. The sensitivity was 85% (17/20), specificity was 76% (16/21), and accuracy was 80% (33/41).


CONCLUSIONS
MR arthrography of the distal radioulnar joint is accurate in depiction of peripheral tears of the ulnar attachment of the triangular fibrocartilage. These tears often appear as noncommunicating tears extending from the distal radioulnar joint into the triangular fibrocartilage.
Rüegger
Christoph
C
Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland.
Schmid
Marius R
MR
Pfirrmann
Christian W A
CW
Nagy
Ladislav
L
Gilula
Louis A
LA
Zanetti
Marco
M
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D005260:Female; D050724:Fractures, Cartilage / Q000175:diagnosis*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D051478:Triangular Fibrocartilage / Q000293:injuries* / Q000473:pathology*; D014954:Wrist Injuries / Q000175:diagnosis*; D014955:Wrist Joint / Q000473:pathology*
D003287:Contrast Media; D019786:Gadolinium DTPA