Sven Mutze MD,PhD, Presenter: Nothing to Disclose

Grit Rademacher MD, Abstract Co-Author: Nothing to Disclose

Dirk Stengel MD, Abstract Co-Author: Nothing to Disclose

Andreas Eisenschenk MD, PhD, Abstract Co-Author: Nothing to Disclose

Katharina Prey, Abstract Co-Author: Nothing to Disclose

Norbert Hosten MD, Abstract Co-Author: Nothing to Disclose

Managing post-traumatic wrist pain refractory to multimodal treatment demands close collaboration between radiologists and hand surgeons. Missed injuries to the scapholunar (SLL) or triquetro-lunar (TLL) ligaments and the triangular fibrocartilage complex (TFCC) pose a high risk for arthrosis. We prospectively evaluated the accuracy of digital radiographic studies and direct magnet resonance arthrography (DMRA) to detect these lesions.

Consecutive patients scheduled for arthroscopy at the discretion of hand surgeons underwent preoperative imaging by digital radiographic cine studies, arthrography, and DMRA. All images were reviewed by an experienced radiologist on a RIS/PACS work station. Interobserver agreement between radiologists and hand surgeons was assessed by kappa statistics. We calculated sensitivity (SN) and specificity (SP), and compared binormal areas under the receiver operating characteristics curves (AUC) by the chi2-test.

Between March 2003 and October 2004, 14 men and 10 women (mean age 38.9 [standard deviation 12.1] years) entered the study. Initial kappa between arthroscopy and imaging was substantial (>0.6) for TFCC and TLL, but fair (0.25) for SLL ruptures. Surgeons and radiologists consented on a synopsis of clinical, arthroscopic and imaging findings to be used as the reference standard rather than arthroscopy alone. The prevalence of SLL, TLL, and TFCC tears was estimated at 8/24, 6/24, and 5/24. SN, SP, and AUC of digital cine, arthrography, and DMRA to detect SLL damage were 100%, 87.5% and 93.8%, 100%, 100% and 100%, and 87.5%, 81.3% and 84.4%, respectively (p=0.127). Arthrography and DMRA provided SNs, SPs and AUCs of 60%, 73.7% and 90%, and 100%, 100% and 100% in TFCC tears (p=0.317). DMRA was superior to digital cine and arthrography for detecting TLL injuries (SN 100%, SP 100%, AUC 100% versus SN 66.7%, SP 88.9%, AUC 77.8% versus SN 83.3%, SP 94.4%, AUC 88.9%, p=0.032).

DMRA precisely detects TLL and TFCC injuries, but is still outperformed by contrast-enhanced digital radiography in revealing SLL ruptures. Staged imaging is recommended for clearing chronic post-traumatic wrist pain.

Mutze, S, Rademacher, G, Stengel, D, Eisenschenk, A, Prey, K, Hosten, N, Accuracy of Digital Radiographic Cine Studies, Arthrography, and Direct Magnetic Resonance Arthrography for Diagnosing Traumatic Lesions of the Intrinsic Ligaments and the Triangular Fibrocartilage Complex of the Wrist.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4410654.html