title: Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears.
abstract: OBJECTIVE
  To classify triangular fibrocartilage complex (TFCC) foveal lesions on the basis of computed tomography (CT) arthrography using a radial plane view and to correlate the CT arthrography results with surgical findings. We also tested the interobserver and intra-observer reliability of the radial plane view.
  
  
  METHODS
  A total of 33 patients with a suspected TFCC foveal tear who had undergone wrist CT arthrography and subsequent surgical exploration were enrolled. We classified the configurations of TFCC foveal lesions into 5 types on the basis of CT arthrography with the radial plane view in which the image slices rotate clockwise centered on the ulnar styloid process. Sensitivity, specificity, and positive predictive values were calculated for each type of foveal lesion in CT arthrography to detect foveal tears. We determined interobserver and intra-observer agreements using kappa statistics. We also compared accuracies with the radial plane views with those with the coronal plane views.
  
  
  RESULTS
  Among the tear types on CT arthrography, type 3, a roundish defect at the fovea, and type 4, a large defect at the overall ulnar insertion, had high specificity and positive predictive value for the detection of foveal tears. Specificity and positive predictive values were 90% and 89% for type 3 and 100% and 100% for type 4, respectively, whereas sensitivity was 35% for type 3 and 22% for type 4. Interobserver and intra-observer agreement was substantial and almost perfect, respectively. The radial plane view identified foveal lesion of each palmar and dorsal radioulnar ligament separately, but accuracy results with the radial plane views were not statistically different from those with the coronal plane views.
  
  
  CONCLUSIONS
  Computed tomography arthrography with a radial plane view exhibited enhanced specificity and positive predictive value when a type 3 or 4 lesion was identified in the detection of a TFCC foveal tear compared with historical controls.
  
  
  METHODS
  Diagnostic II.
authors.affiliation: Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan. Electronic address: hisao-moritomo@yukioka-u.ac.jp.
authors.forename: Hisao
authors.initials: H
authors.lastname: Moritomo
authors.affiliation: Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Arimitsu
authors.affiliation: Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Masatomi
authors.affiliation: Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yukioka
mesh_terms: D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods*; D001182:Arthroscopy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051478:Triangular Fibrocartilage / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D014954:Wrist Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
keywords: Computed tomography arthrography; diagnostic accuracy; radial plane view; triangular fibrocartilage complex foveal tear; ulnar-sided wrist pain