MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist

Abstract

IntroductionIn case of clinical suspicion of triangular fibrocartilage complex (TFCC) injury, different imaging techniques are used. The aim of this study was to determine whether MRA is superior to MRI and whether 3.0 T is better than 1.5 T (expresses in sensitivity, specificity and accuracy) in detecting TFCC injury, using arthroscopy as the gold standard.Materials and methodsThe arthroscopic and MR findings of 150 patients who underwent arthroscopy for ulnar-sided wrist pain between January 2009 and November 2016 were retrospectively reviewed.ResultsMRA was slightly more accurate compared to conventional MRI, and 1.5 T was slightly more accurate than 3.0 T. 1.5 T wrist MRA had a sensitivity of 80%, a specificity of 100% and accuracy of 90%; 3.0 T wrist MRA 73, 100 and 86%, resp. Conventional 1.5 T wrist MRI had a sensitivity of 71%, a specificity of 75% and accuracy of 73%. For 3.0 T conventional MRI, this was 73, 67 and 70%, resp.ConclusionsMRA seems slightly superior to conventional MRI, but one could question whether this difference in diagnostic accuracy outweighs the burden and risks of an invasive procedure for patients with its additional costs. Furthermore, we could not confirm the superiority of 3 T compared to 1.5 T.

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

“…The clinical care setting was described in 9 out of 23 studies and was obtained by contacting the authors for an additional 4 studies: a private hand clinic, 33 ED, 31 38 department for hand and plastic surgery, 24 27 34 36 41 surgery, 45 orthopaedics department 27 34 and in an emergency room and outpatient clinic of a surgery and orthopaedics department. 39 Despite multiple attempts to contact the authors by email, clarification regarding the setting could not be obtained for the remaining 10 studies.…”

“…Eight studies were retrospective [23][24][25][26][27][28][29][30] nine studies were prospective [31][32][33][34][35][36][37][38][39] and six studies [40][41][42][43][44][45] gave no description of the study design. Eight studies 23 25 27 31 33 36 43 45 included more than 60 participants; six of these studies 23 25 27 31 33 36 described wrist pathologies and two 43 45 described hand pathologies.…”

Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

“…Clinical examination, X-rays, and MRI examination may be helpful in opting for the use of wrist arthroscopy. However, wrist arthroscopy is considered the diagnostic gold standard; therefore, it is obvious that arthroscopic repair should be attempted in the same operation [ 33 , 34 , 35 ].…”

Narrative Review of Ligamentous Wrist Injuries

“… 45 46 47 MR arthrogram is widely supported as the test of choice for detecting TFCC tears, as it has an accuracy of 79 to 100% in detecting TFCC tears with improved localization of the site of injury; however, prior investigation has found 3.0 T MRI with dedicated coils to be only slightly less accurate than MR arthrogram. 48 49 50 51 Furthermore, axial traction may increase the rate of detection of a TFCC tear. 52 CT arthrogram has been explored as an alternative diagnostic modality, with a recent meta-analysis suggesting that its sensitivity and specificity are statistically equivalent to that of MR arthrogram.…”