MDCT arthrography of the wrist: diagnostic accuracy and indications.
OBJECTIVE
To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard.


METHODS
After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study.


RESULTS
In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k=0.96) and statistically significant (p<0.05).


CONCLUSIONS
Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.
De Filippo
Massimo
M
Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma, Italy.
Pogliacomi
Francesco
F
Bertellini
Annalisa
A
Araoz
Philip A
PA
Averna
Raffaele
R
Sverzellati
Nicola
N
Ingegnoli
Anna
A
Corradi
Maurizio
M
Costantino
Cosimo
C
Zompatori
Maurizio
M
D000328:Adult; D018771:Arthralgia / Q000175:diagnosis / Q000000981:diagnostic imaging; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014954:Wrist Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging*