Soenke Langner MD, PhD, Abstract Co-Author: Nothing to Disclose

Inga Langner MD, Abstract Co-Author: Nothing to Disclose

Paul-Christian Krueger MD, Abstract Co-Author: Nothing to Disclose

Rebecca Kessler MD, Abstract Co-Author: Nothing to Disclose

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

Per-Olaf Behrndt MD, Presenter: Nothing to Disclose

Posttraumatic injuries of the scapholunate ligament (SLL) may cause scapholunate dissociation (SLD) which bears a high risk of osteoarthritis. Plain radiographs are used for initial diagnostic work up and MR imaging (MRI) is the preferred imaging modality for the assessment of ligamentous injuries. However, dynamic instability can only be assessed by cineradiography. The aim of the study was to evaluate diagnostic accuracy of cine-MRI for the assessment of SLD in comparison to arthroscopy.

23 Patients with clinically suspected SLD were included. All patients underwent static MRI and cine-MRI of wrist at 3T. We acquired T2-weighted (T2w) images in axial and coronal planes and sagittal T1w images. Cine-MRI was performed from extreme radial to ulnar abduction and during clenching and unclenching of the fist with a temporal resolution of 5 images/s. Cineradiography was performed in all patients with a temporal resolution of 12.5 images/s. Afterwards all patients underwent arthroscopy. Images were evaluated by one hand surgeon and one experienced MSK radiologist blinded for intraoperative finding. Cineradiography and cine-MRI were evaluated for scapholunate (sl) distance, sl alignement, synchronous motion of carpal bones and continuitiy of Gilula lines. Sensitivity, specificity, positive (pLR) and negative (nLR) likelihood ratio for cine-MRI with respect to intraoperative findings were calculated. Differences between cineradiography and cine-MRI were evaluated using t-test. A p-value <0.05 was considered statistically significant.

Cine-MRI was of diagnostic quality in all patients. There was no statistical significant difference between cineradiography and cine-MRI (p=0.081). SLD was correctly diagnosed in 5 patients and excluded in 16 patients. SLD was diagnosed false positive and negative in one case each. Sensitivity and specifity of cine-MRI for SLD was 83% and 94%, respectively. PLR and nLR was 13,83 and 0,18 respectively.

Cine-MRI has a high sensitivity and specificity for the diagnosis of SLD. It can be easily integrated in conventional MR imaging and may eliminate the need for cineradiography.

CINE-MRI is a safe and feasible method to identify scapholunate dissociation and may prevent exposure of the patients to radiation.

Langner, S, Langner, I, Krueger, P, Kessler, R, Eisenschenk, A, Behrndt, P, Diagnosis of Scapholunate Dissociation: Cine-MR Imaging as a New Approach.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002699.html