title: Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis.
abstract: BACKGROUND
  Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulnar-sided wrist pain and resultant functional disability. Diagnosis is based on the history and clinical examination as well as radiographic evidence of a TFCC central perforation or a radial/ulnar tear. The purpose of this study was therefore to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the detection of TFCC injury in the adult population.
  
  
  METHODS
  Published and unpublished literature databases were searched. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary receiver operating characteristic curve evaluations were performed. The methodological quality of each study was assessed with use of the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool.
  
  
  RESULTS
  Twenty-one studies were included in the review, and these series included a total of 982 wrists. On meta-analysis, MRA was superior to MRI in the investigation of full-thickness TFCC tears, with a pooled sensitivity of 0.75 and a pooled specificity of 0.81 for MRI compared with 0.84 and 0.95, respectively, for MRA. MRA and MRI performed at greater field strengths were reported to have greater sensitivity and specificity than those performed at lower field strengths. There were insufficient data to assess the diagnostic test accuracy for partial-thickness TFCC tears.
  
  
  CONCLUSIONS
  Given its acceptable diagnostic test accuracy, it is recommended that MRA, rather than MRI, be performed in when there are questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain.
authors.affiliation: Faculty of Health, University of East Anglia, Norwich, United Kingdom. toby.smith@uea.ac.uk
authors.forename: Toby O
authors.initials: TO
authors.lastname: Smith
authors.forename: Benjamin
authors.initials: B
authors.lastname: Drew
authors.forename: Andoni P
authors.initials: AP
authors.lastname: Toms
authors.forename: Christina
authors.initials: C
authors.lastname: Jerosch-Herold
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Chojnowski
mesh_terms: D000328:Adult; D001175:Arthrography; D006801:Humans; D008279:Magnetic Resonance Imaging; D012680:Sensitivity and Specificity; D051478:Triangular Fibrocartilage / Q000293:injuries*; D014954:Wrist Injuries / Q000175:diagnosis*