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Skeletal Radiology

, Volume 42, Issue 9, pp 1277–1285 | Cite as

Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography

  • Ryan K. L. Lee
  • Alex W. H. Ng
  • Cina S. L. Tong
  • James F. Griffith
  • W. L. Tse
  • C. Wong
  • P. C. Ho
Scientific Article

Abstract

Purpose

This study compares the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist.

Materials and methods

Ten cadaveric wrists of five male subjects with an average age 49.6 years (range 26–59 years) were evaluated using CTA, conventional 3-T MR and MRA. We assessed the presence of scapholunate ligament (SLL), lunotriquetral ligament (LTL), and TFCC tears using a combination of conventional arthrography and arthroscopy as a gold standard. All images were evaluated in consensus by two musculoskeletal radiologists with sensitivity, specificity, and accuracy being calculated.

Results

Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100 %/100 %/100 %, 66 %/86 %/80 %, 100 %/86 %/90 % for the detection of SLL tear, 100 %/80 %/90 %, 60 %/80 %/70 %, 100 %/80 %/90 % for the detection of LTL tear, and 100 %/100 %/100 %, 100 %/86 %/90 %, 100 %/100 %/100 % for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities.

Conclusion

Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging.

Keywords

Intrinsic ligament Triangular fibrocartilage complex Conventional arthrogram MR arthrogram CT arthrogram 

Notes

Acknowledgments

The work described in this paper was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No.SEG_CUHK02).

Conflict of interest

No conflict of interest.

References

  1. 1.
    Linkous MD, Pierce SD, Gilula LA. Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics. Radiology. 2000;216:846–50.PubMedGoogle Scholar
  2. 2.
    Zlatkin MB, Chao PC, Osterman AL, Schnall MD, Dalinka MK, Kressel HY. Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology. 1989;173:723–9.PubMedGoogle Scholar
  3. 3.
    Schweitzer ME, Brahme SK, Hodler J, et al. Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography. Radiology. 1992;182:205–11.PubMedGoogle Scholar
  4. 4.
    Totterman SM, Miller RJ, McCance SE, Meyers SP. Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence. Radiology. 1996;199:227–32.PubMedGoogle Scholar
  5. 5.
    Golimbu CN, Firooznia H, Melone Jr CP, Rafii M, Weinreb J, Leber C. Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology. 1989;173:731–3.PubMedGoogle Scholar
  6. 6.
    Haims AH, Schweitzer ME, Morrison WB, et al. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol. 2002;178:419–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Rüegger C, Schmid MR, Pfirrmann CW, Nagy L, Gilula LA, Zanetti M. Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol. 2007;188:187–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2012;37:1489–500.PubMedCrossRefGoogle Scholar
  9. 9.
    Jacobson JA, Oh E, Propeck T, Jebson PJ, Jamadar DA, Hayes CW. Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy. AJR Am J Roentgenol. 2002;179:523–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Timins ME, Jahnke JP, Krah SF, Erickson SJ, Carrera GF. MR imaging of the major carpal stabilizing ligaments: normal anatomy and clinical examples. Radiographics. 1995;15:575–87.PubMedGoogle Scholar
  11. 11.
    Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 2009;192:80–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee YH, Choi YR, Kim S, Song HT, Suh JS. Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging. 2013;31:221–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Mahmood A, Fountain J, Vasireddy N, Waseem M. Wrist MRI arthrogram v wrist arthroscopy: what are we finding? Open Orthop J. 2012;6:194–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Manton GL, Schweitzer ME, Weishaupt D, Morrison WB, Osterman AL, Culp RW, et al. Partial interosseous ligament tears of the wrist: difficulty in utilizing either primary or secondary MRI signs. J Comput Assist Tomogr. 2001;25:671–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Berná-Serna JD, Martínez F, Reus M, Alonso J, Doménech G, Campos M. Evaluation of the triangular fibrocartilage in cadaveric wrists by means of arthrography, magnetic resonance (MR) imaging, and MR arthrography. Acta Radiol. 2007;48:96–103.PubMedCrossRefGoogle Scholar
  16. 16.
    Schmid MR, Schertler T, Pfirrmann CW, Saupe N, Manestar M, Wildermuth S, et al. Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology. 2005;237:1008–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Moser T, Dosch JC, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol. 2007;188:1278–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Theumann N, Favarger N, Schnyder P, Meuli R. Wrist ligament injuries: value of post-arthrography computed tomography. Skeletal Radiol. 2001;30:88–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am. 2009;34:395–400.PubMedCrossRefGoogle Scholar
  20. 20.
    Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996;78:357–65.PubMedGoogle Scholar
  21. 21.
    Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am. 1993;18:463–75.PubMedCrossRefGoogle Scholar
  22. 22.
    Lee DH, Dickson KF, Bradley EL. The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study. J Hand Surg Am. 2004;29:676–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Wright TW, Del Charco M, Wheeler D. Incidence of ligament lesions and associated degenerative changes in the elderly wrist. J Hand Surg Am. 1994;19:313–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Rimington TR, Edwards SG, Lynch TS, Pehlivanova MB. Intercarpal ligamentous laxity in cadaveric wrists. J Bone Joint Surg Br. 2010;92:1600–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Weiss CB. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2008;90:1169–70.PubMedGoogle Scholar
  26. 26.
    Wong TC, Yip TH, Wu WC. Carpal ligament injuries with acute scaphoid fractures—a combined wrist injury. J Hand Surg Br. 2005;30:415–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Herbert TJ, Faithfull RG, McCann DJ, Ireland J. Bilateral arthrography of the wrist. J Hand Surg Br. 1990;15:233–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Robinson G, Chung T, Finlay K, Friedman L. Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience. Skeletal Radiol. 2006;35:765–73.PubMedCrossRefGoogle Scholar
  29. 29.
    Smith DK, Snearly WN. Lunotriquetral interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology. 1994;191:199–202.PubMedGoogle Scholar
  30. 30.
    Haims AH, Schweitzer ME, Morrison WB, et al. Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology. 2003;227:701–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol. 1997;168:1513–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Zanetti M, Bräm J, Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging. 1997;7:590–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Brown RR, Fliszar E, Cotten A, Trudell D, Resnick D. Extrinsic and intrinsic ligaments of the wrist: normal and pathologic anatomy at MR arthrography with three-compartment enhancement. Radiographics. 1998;18:667–74.PubMedGoogle Scholar
  34. 34.
    Schweitzer ME, Natale P, Winalski CS, Culp R. Indirect wrist MR arthrography: the effects of passive motion versus active exercise. Skeletal Radiol. 2000;29:10–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Scheck RJ, Kubitzek C, Hierner R, Szeimies U, Pfluger T, Wilhelm K, et al. The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy. Skeletal Radiol. 1997;26:263–71.PubMedCrossRefGoogle Scholar
  36. 36.
    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2008;33:1669–79.PubMedCrossRefGoogle Scholar
  37. 37.
    Scheck RJ, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K. The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging. 1999;9:468–74.PubMedCrossRefGoogle Scholar
  38. 38.
    Totterman SM, Miller RJ. Scapholunate ligament: normal MR appearance on three-dimensional gradient-recalled-echo images. Radiology. 1996;200:237–41.PubMedGoogle Scholar
  39. 39.
    Yoshioka H, Tanaka T, Ueno T, Shindo M, Carrino JA, Lang P, et al. High-resolution MR imaging of the proximal zone of the lunotriquetral ligament with a microscopy coil. Skeletal Radiol. 2006;35:288–94.PubMedCrossRefGoogle Scholar
  40. 40.
    Shigematsu S, Abe M, Onomura T, Kinoshita M, Inoue T. Arthrography of the normal and posttraumatic wrist. J Hand Surg Am. 1989;14:410–2.PubMedCrossRefGoogle Scholar
  41. 41.
    Dautel G, Goudot B, Merle M. Arthroscopic diagnosis of scapho-lunate instability in the absence of X-ray abnormalities. J Hand Surg Br. 1993;18:213–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith DK. Scapholunate interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology. 1994;192:217–21.PubMedGoogle Scholar

Copyright information

© ISS 2013

Authors and Affiliations

  • Ryan K. L. Lee
    • 1
  • Alex W. H. Ng
    • 1
  • Cina S. L. Tong
    • 1
  • James F. Griffith
    • 1
  • W. L. Tse
    • 1
    • 2
  • C. Wong
    • 1
    • 2
  • P. C. Ho
    • 1
    • 2
  1. 1.Department of Imaging and Interventional Radiology, Prince Of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  2. 2.Department of Orthopedics, Prince Of Wales HospitalThe Chinese University of Hong KongShatinHong Kong

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