Limitations of MR Imaging in the Diagnosis of Peripheral Tears of the  Triangular Fibrocartilage of the Wrist

Haims, Andrew; Schweitzer, Mark E.; Morrison, William B.; Deely, Diane M.; Lange, Robert; Osterman, A. Lee; Bednar, John M.; Taras, John S.; Culp, Randall W.

doi:10.2214/ajr.178.2.1780419

Cited by 127 publications

(75 citation statements)

References 17 publications

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“…Multiple factors can play a major role in MRI accuracy in detecting TFCC lesions; the magnetic field strength is one of these factors as it was shown by Anderson et al who suggested that imaging with 3.0 T offers higher quality at a given spatial resolution [10]. Special coils were used while scanning and the area under investigation also have their reflection on the accuracy of imaging [15,20]. Moreover, Haims et al reported that MRI was not accurate in detecting TFCC abnormalities, especially peripheral tears (avascular area), and that the experience of the radiologist interpreting the MRI findings has a significant influence on the ability to detect and localize TFCC abnormalities [20].…”

Section: Discussionmentioning

confidence: 99%

“…Special coils were used while scanning and the area under investigation also have their reflection on the accuracy of imaging [15,20]. Moreover, Haims et al reported that MRI was not accurate in detecting TFCC abnormalities, especially peripheral tears (avascular area), and that the experience of the radiologist interpreting the MRI findings has a significant influence on the ability to detect and localize TFCC abnormalities [20].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Triangular Fibrocartilage Complex Abnormalities among Asymptomatic Young Individuals Using Magnetic Resonance Imaging in A Tertiary Center in Saudi Arabia: A Cross-Sectional Study

Fairag¹,

Alshareef²,

Alharbi³

et al. 2017

Med Case Rep

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This study aims to detect and evaluate abnormalities and injuries of triangular fibrocartilage complex (TFCC) using 3.0 T high-resolution MRI. It also determines its efficacy among young asymptomatic individuals. This is a cross sectional exploratory study with a sample size of 30 (21 women and 9 men). None of the volunteers showed signs for previous wrist injuries. Details of TFCC morphology were determined using MRI images for dominant wrist. Analysis of locations for tear or degeneration or any characteristics was also performed. An incomplete or partial tear was presented by 5 volunteers (all women) whereas degeneration or complete tear was absent. Besides, 25 volunteers showed an intact ligament including all men. Prevalence of incidental TFCC is found to be less insignificant. The fact that participants showed less prevalence of asymptomatic abnormalities can be related to their young age. Close correlation of the findings with physical examination and history of individuals is required. Level of Evidence:Diagnostic, Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of Triangular Fibrocartilage Complex Abnormalities among Asymptomatic Young Individuals Using Magnetic Resonance Imaging in A Tertiary Center in Saudi Arabia: A Cross-Sectional Study

Fairag¹,

Alshareef²,

Alharbi³

et al. 2017

Med Case Rep

View full text Add to dashboard Cite

show abstract

“…Their conclusion was that MRI without intra-articular contrast medium is unreliable in excluding tears of the intrinsic ligaments. Moreover, despite showing a high accuracy of 97% for central and radial sided TFC tears [30,35,50,59] (Palmer's class IA, ID and class II tears), MRI is only 64% accurate [15,50] for peripheral tears of the ulnar attachment (Palmer's class IB and IC). The poor performance of MR for these tears was attributed to the presence of high-signal vascularized fibrous tissue between the two ulnar attachments, the ligamentum subcruentum [3,15], which can mimic a tear.…”

Section: Discussionmentioning

confidence: 99%

MR Arthrography of the Wrist: Controversies and Concepts

Maizlin¹,

Brown

Clement

et al. 2008

Hand (New York, N,Y.)

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Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. Thirty-one consecutive direct magnetic resonance arthrographic examinations of the wrist using a wrist surface coil were performed for the assessment of the TFCC and intrinsic ligaments on a 1.5-T MR imaging system (Signa; 16 channel, Excite, GE Healthcare, Milwaukee, WI, USA). All patients had wrist pain, and in six cases, there was associated clinical carpal instability. The presence, location, and extent of TFCC, scapholunate ligament (SLL), and lunotriquetral ligament (LTL) lesions on T1 fat-saturated, multiplanar gradient recalled (MPGR) and short tau inversion recovery (STIR) images were identified, compared, and analyzed. Forty-one lesions of the TFCC, SLL, and LTL were visualized on contrast-sensitive (T1 fat-saturated) images in 23/31 (74.2%) patients. Twenty-one lesions of the TFCC and intrinsic ligaments were visualized on noncontrast-sensitive (MPGR and STIR) images (15 tears of the TFCC and six tears of the SLL and LTL). All of these lesions were seen on T1 fat-saturated images; 48.8% (20/41) lesions seen on T1 fat-saturated images (eight tears of TFCC and 12 tears of SLL and LTT) were not seen on MPGR and/or STIR images. Superior contrast resolution, joint distention, and the flow of contrast facilitate the diagnosis of lesions of the TFCC and intrinsic ligaments on contrast-sensitive sequences making MRA the preferred modality for imaging internal derangements of the wrist. Little agreement exists regarding the value and location of perforations of the intrinsic ligaments given that both traumatic and degenerative perforations may be symptomatic. Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain.

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“…Haims et al found that the sensitivity, specificity and accuracy of detection of peripheral ulnar tear were only 17%, 79% and 64% only (31).…”

Section: Pitfalls Of Mri In Tfcc Tear Detectionmentioning

confidence: 99%

“…This peripheral tear is the most commonly missed. Indirect clues include altered morphology, excessive fluid accumulation and focal synovitis around this region (31). MR arthrography of the DRUJ will also help to depict tears at the foveal attachment.…”

Section: Mri Features Of Tfcc Tearmentioning

confidence: 99%

MR imaging of the traumatic triangular fibrocartilaginous complex tear

Ng¹,

Griffith²,

Fung³

et al. 2017

Quant. Imaging Med. Surg.

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Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ).However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.

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Limitations of MR Imaging in the Diagnosis of Peripheral Tears of the Triangular Fibrocartilage of the Wrist

Abstract: MR imaging does not adequately reveal the peripheral attachment of the triangular fibrocartilage complex.

Cited by 127 publications

References 17 publications

Prevalence of Triangular Fibrocartilage Complex Abnormalities among Asymptomatic Young Individuals Using Magnetic Resonance Imaging in A Tertiary Center in Saudi Arabia: A Cross-Sectional Study

Prevalence of Triangular Fibrocartilage Complex Abnormalities among Asymptomatic Young Individuals Using Magnetic Resonance Imaging in A Tertiary Center in Saudi Arabia: A Cross-Sectional Study

MR Arthrography of the Wrist: Controversies and Concepts

MR imaging of the traumatic triangular fibrocartilaginous complex tear

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