Adam Zoga MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Cystic lesions in the capitate are frequently encountered on MRI examinations of the wrist. Traditionally, many of these lesions were thought to be related to arthritis or overlying cartilage defects. However, we have observed frequent capitate cysts, even in the absence of observable articular disease. Therefore, we sought to systematically describe and categorize cystic lesions of the capitate with arthroscopic corellation. Methods and Materials: At 1.5T, 40 patients, all with subsequent wrist arthroscopy, were systematically evaluated. Two radiologists blinded to the clinical setting, symptoms, radiographic and arthroscopic findings, retrospectively reviewed images for the presence, quantity, size and precise location,as well as enhancement patterns of cystic lesions in the capitate. Also noted was the presence of adjacent articular disease. Arthroscopic reports from all patients were reviewed for evidence of cartilage defects, arthritic changes, visible capitate lesions and penetrating ligaments or vessels. Results: Cystic lesions in the capitate were present in 31/40 (78%)patients; 15 (48%)of which were multiple. Sizes ranged from 1mm-7mm in diameter, (mean 2.9mm). The most common location was volar/ulnar just proximal to the waist (n=18). Next most freqent was dorsal/radial at the level of the waist (n=16). A pattern of cysts at both of these locations were seen in 9/40 (23%) patients. In 11/40 (28%) patients, cysts were seen, close to, but not precisely at the above locations (volar/radial/proximal, volar/radial/distal). Other locations were sporadic and variable (dorsal/ulnar/distal n=1, volar/ulnar/distal n=2, dorsal/ulnar/proximal n=1). Five additional patients were noted to have linear fluid signal without discrete cysts at the two most common locations described above 12.5%). Enhancement patterns were variable as well (18 enhancing, 5 non-enhancing). At arthroscopy, no cysts were visible, and there were only 3 capitate cartilage defects reported in 2 patients, neither with adjacent cysts at MR. At surgery, the cysts seemed to correspond to the sites of ligamentous attachments. No correlative penetrating vessels were noted, and no relationship was demonstrated between cystic lesions in the capitate and osteoarthritis. Conclusion: Cystic lesions of the capitate are commonly seen on MR and are rarely associated with either cartilage defects, or morphologic cysts. They occur in typical and reproducable locations, and may represent sites of cortical weakening at ligamentous insertions.       Questions about this event email: adam.zoga@mail.tju.edu

Zoga MD, A, Cystic Lesions of the Capitate: MR-Arthroscopic Correlation.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3101106.html