title: Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation.
abstract: Introduction. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data.Methods. Microcomputed tomography (μ-CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain.Results. TFCC reconstruction was impossible usingμ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B).Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach ofμ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool.
authors.affiliation: Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, University of Leipzig, Leipzig, Germany.
authors.forename: Niels
authors.identifier: 0000-0001-8230-9383
authors.initials: N
authors.lastname: Hammer
authors.affiliation: Department of Anatomy, University of Leipzig, Leipzig, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hirschfeld
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Leipzig, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Strunz
authors.affiliation: Fraunhofer Institute for Machine Tools and Forming Technology (IWU), Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Werner
authors.affiliation: Department of Anatomy, University of Leipzig, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolfskämpf
authors.affiliation: Department of Anatomy, University of Leipzig, Leipzig, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Löffler
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D051478:Triangular Fibrocartilage / Q000000981:diagnostic imaging* / Q000473:pathology*; D055114:X-Ray Microtomography