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The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI

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Abstract

Objective

To determine if magic angle plays a role in apparent central increased signal intensity of the distal extensor carpi ulnaris tendon (ECU) on MRI, to see if histologic findings of tendon degeneration are associated with increased T1 or T2 tendon signal on MR imaging, and to determine the prevalence of the ECU “pseudolesion”.

Materials and methods

A standard 3 Tesla protocol was utilized to scan ten cadaveric wrists. A 40 mm length of 10 ECU and four extensor carpi radialis brevis (ECRB) tendons were immersion fixed before microCT scanning. Staining with Alcian blue, Masson’s trichrome and Safranin O was performed before light microscopy. Fifty clinical wrist MRIs were also reviewed for the presence of increased T1 and/or T2 signal.

Results

Central increased T1 and/or T2 signal was observed in 9 of 10 cadaveric ECU tendons, but not in ECRB tendons. MicroCT and histology showed inter-tendinous matrix between the two distal heads of the ECU. Increased mucoid degeneration correlated with increased MRI signal intensity. The tendon fibers were at a maximum of 8.39° to the longitudinal axis on microCT. Clinical MRIs showed increased T1 signal in 6 %, increased T2 signal in 8 %, increased T1 and T2 signal in 80 %, and 6 % showing no increased signal.

Conclusion

Central increased T1 and/or T2 signal in the ECU tendon indicates the presence of normal inter-tendinous ground substance, with increased proteoglycan content (mucoid degeneration) responsible for increased signal intensity. None of the fibers were shown on microCT to approach the magic angle.

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Acknowledgments

Roshanak Razmpour, for preparation of the histology slides.

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Nothing to disclose

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Authors and Affiliations

  1. Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA

    Sayed Ali, Ryan Cunningham & Feroze Mohamed

  2. Department of Anatomy, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA

    Mamta Amin, Steven N. Popoff & Mary F. Barbe

Authors
  1. Sayed Ali
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  2. Ryan Cunningham
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  3. Mamta Amin
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  4. Steven N. Popoff
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  5. Feroze Mohamed
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Correspondence to Sayed Ali.

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Ali, S., Cunningham, R., Amin, M. et al. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI. Skeletal Radiol 44, 1735–1743 (2015). https://doi.org/10.1007/s00256-015-2224-3

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  • DOI: https://doi.org/10.1007/s00256-015-2224-3

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