title: Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage.
abstract: OBJECTIVE
  The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments.
  
  
  METHODS
  A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction.
  
  
  RESULTS
  With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears.
  
  
  CONCLUSIONS
  Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.
authors.affiliation: 1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Ryan K L
authors.initials: RK
authors.lastname: Lee
authors.affiliation: 1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: James F
authors.initials: JF
authors.lastname: Griffith
authors.affiliation: 1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Alex W H
authors.initials: AW
authors.lastname: Ng
authors.affiliation: 1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Ryan C H
authors.initials: RC
authors.lastname: Nung
authors.affiliation: 1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: David K W
authors.initials: DK
authors.lastname: Yeung
mesh_terms: D000328:Adult; D001175:Arthrography; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008023:Ligaments, Articular / Q000293:injuries*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D014143:Traction; D051478:Triangular Fibrocartilage / Q000293:injuries*; D014954:Wrist Injuries / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D007472:Iohexol; D008536:Meglumine; C072417:gadoterate meglumine
keywords: MR arthrography; articular cartilage; intrinsic ligament; triangular fibrocartilage complex; wrist traction