MDCT arthrography of the wrist: Diagnostic accuracy and indications

Filippo, Massimo De; Pogliacomi, Francesco; Bertellini, Annalisa; Araoz, Philip A.; Averna, R.; Sverzellati, Nicola; Ingegnoli, Anna; Corradi, Massimiliano; Cipolla, Costantino; Zompatori, Maurizio

doi:10.1016/j.ejrad.2009.01.023

Cited by 45 publications

(23 citation statements)

References 19 publications

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“…The second highest agreement was found in CT, however, with lower accuracy. A higher interobserver agreement with values of 1.00 for TFCC and cartilage lesions and 0.89 for ligament lesions was found in the study by De Filippo and co-workers analyzing CT arthrography in patients with degenerative or posttraumatic arthropathy of the wrist [24]. These differences are probably based on the use of contrast medium.…”

Section: Discussionmentioning

confidence: 89%

Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT, MRI, CT, Bone Scan and Plain Radiographs

et al. 2013

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PurposeChronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population.Materials and MethodsThirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan), late-phase imaging (SPECT/CT including bone scan and CT), and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities. ResultsThe most accurate modality for experienced readers was SPECT/CT (accuracy 77%), followed by MRI (56%). The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%), followed by MRI and bone scan (38% each). The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72), localisation (kappa 0.91, MRI 0.75) and etiology (kappa 0.85, MRI 0.74), while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69). There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI. ConclusionsSPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain.

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Section: Discussionmentioning

confidence: 89%

Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT, MRI, CT, Bone Scan and Plain Radiographs

et al. 2013

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“…Recent works suggest that DRUJ instability may be caused by ulnar detachment of the TFC complex, with the foveal insertion having a greater effect on stability than the styloid insertion. [12][13][14][15][16][17][18][19][20][21][22]…”

Section: Proximal Portion Of the Tfc Complexmentioning

confidence: 99%

MR and CT Arthrography of the Wrist

Cerezal

Berná-Mestre

Canga

et al. 2012

Semin Musculoskelet Radiol

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The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries.

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“…[12][13][14][15][16][17][18][19][20][21][22] Palmer class 1A and 1B lesions are by far the most common types of TFC complex injuries. 4): class IA (Avascular disc central slit), class IB (Base of the ulnar styloid avulsion), class IC (Carpal avulsion), and Class ID (ra"D"ial avulsion).…”

Section: Traumatic Tears Of Tfc Complexmentioning

confidence: 99%

“…The variable combination of styloid fractures and ligamentous injuries of the ulnar side of the wrist has been defined as a "constellation" of ligamentous, osseous, and capsular damage. [14][15][16][17][18][19] Class ID (Ra"D"Ial Detachment) As discussed in the anatomy section, the connection from the hyaline cartilage of the radius to the TFC indicates a rather weaker connection than the peripheral ligament-bone connection. Peripheral partial tears with only styloid insertion involvement (noncommunicating tear) are not associated with DRUJ instability and may be treated with arthroscopic suture of the distal lamina to the ulnar wrist capsule or ECU tendon sheath.…”

Section: Traumatic Tears With Druj Instabilitymentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20] When there is detachment of both the foveal and styloid insertion of the TFC complex (complete tear), communication between DRUJ and radiocarpal joint is observed at arthrography, and it is important to determine by MR arthrography the retraction of the TFC complex from its ulnar attachment because extensive laceration requires reconstruction with a tendon graft. [14][15][16][17][18][19][20] Degenerative Tears of the TFC Complex: Ulnocarpal Impaction Syndrome Ulnocarpal impaction (UCI) is a degenerative condition characterized by chronic impaction between the ulnar head, the TFC complex, and the ulnar carpus resulting in a continuum of pathological changes (►Fig. 14,16,19 The supposition that the DRUJ is unstable when the nonunion of fracture is located at the base (type II) of the ulnar styloid process, and the opposite when the nonunion is at the tip (type I) has not been confirmed in several arthroscopic studies.…”

Section: Traumatic Tears With Druj Instabilitymentioning

confidence: 99%

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