3T MRI of wrist ligaments and TFCC using true plane oblique 3D T2 Dual Echo Steady State (DESS) – a study of diagnostic accuracy

Abstract

Objective: This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. Methods: In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3D T2 DESS sequence for assessing intrinsic ligaments and triangular fibrocartilage (TFCC). At arthroscopy, tears were classified using Geissler’s classification and compared to MRI findings. Results: The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. Conclusion: 3T wrist MRI with dedicated reformats from 3D T2 DESS has a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3D T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. Advances in knowledge: This study assesses the diagnostic performance of unenhanced 3T MRI with 3D T2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported.

Diffusion tensor imaging combined with the dual-echo steady-state (DESS) protocol for the evaluation of the median nerve in the carpal tunnel: A preliminary study

“…This sequence can provide high-resolution, heavily T2*-weighted images. [ 4 ] The DESS protocol can be used to evaluate the cartilage in the knee or wrist ligament. [ 4 , 15 ] However, to the best of our knowledge, it has not been used to evaluate the median nerve in the carpal tunnel previously.…”

“…[ 4 ] The DESS protocol can be used to evaluate the cartilage in the knee or wrist ligament. [ 4 , 15 ] However, to the best of our knowledge, it has not been used to evaluate the median nerve in the carpal tunnel previously. Since the median nerve is compressed in patients with CTS, we hypothesized that it could be identified vaguely in the images.…”

Clinical validation of the 3-dimensional double-echo steady-state with water excitation sequence of MR neurography for preoperative facial and lingual nerve identification

“… 6 This sequence displays fluid with an extremely bright signal, while showing bone as dark with high resolution. 20 This technique has recently been adopted in MR neurography due to its ability to show nerves with a bright signal due to the endoneurium fluid while suppressing the blood signal. 7 13 20 In addition, compared to conventional T1-WI imaging, which is acquired slice by slice, the 3D-DESS-WE sequence is obtained as a 3D volume image that can freely be reconstructed into a multi-dimensional view.…”

“… 20 This technique has recently been adopted in MR neurography due to its ability to show nerves with a bright signal due to the endoneurium fluid while suppressing the blood signal. 7 13 20 In addition, compared to conventional T1-WI imaging, which is acquired slice by slice, the 3D-DESS-WE sequence is obtained as a 3D volume image that can freely be reconstructed into a multi-dimensional view. This method is advantageous for observing peripheral nerves with a thin diameter and irregular course.…”

Scapholunate Ligament Injuries

“…Improvements in magnetic resonance imaging (MRI) sensitivity, specificity, and negative predictive value of SLIL injury through dedicated true plane reformats of 3D T2 Dual Echo Steady State has increased its utility as a supplement to the clinical findings. 34 MRI provides further benefit by analyzing concomitant pathologic radiographic findings including other carpal ligament tears, triangular fibrocartilage complex injuries, capsular impingement, and tendonitis. CT and fluoroscopy can also provide useful information to supplement the clinical exam.…”