Seun Ah Lee MD, Presenter: Nothing to Disclose

Baek Hyun Kim MD, Abstract Co-Author: Nothing to Disclose

Seon Jeong Oh, Abstract Co-Author: Nothing to Disclose

Jong Woong Park, Abstract Co-Author: Nothing to Disclose

Kyung-Sik Ahn MD, Abstract Co-Author: Nothing to Disclose

Ji Yung Choo MD, Abstract Co-Author: Nothing to Disclose

Suk-Joo Hong MD, Abstract Co-Author: Nothing to Disclose

Chang Ho Kang MD, Abstract Co-Author: Nothing to Disclose

The purposes of this study were to introduce dynamic cine-arthrography (DCA) and compare the diagnostic performance between MR arthrography (MRA) alone and MRA with DCA for evaluating triangular fibrocartilage complex (TFCC) and intrinsic ligament tears.

93 wrists of 88 patients underwent both DCA and MRA from May 2010 to February 2014. Among them, 44 wrists of 42 patients who had undergone arthroscopy were included in this study. DCA was performed during contrast injection for MRA. After puncture of the radio-carpal joint, DCA was taken while slowly injecting contrast under fluoroscopic guidance during passive wrist exercise. We obtained 3.0T MRA with fat-suppressed coronal, sagittal, and axial images. Two radiologist evaluated TFCC, scapho-lunate (S-L) ligament, and luno-triquetral (L-T) ligament tears on MRA and MRA with DCA, respectively. Based on the arthroscophic findings, we compared the diagnostic values between MRA and MRA with DCA by the McNemar test.

The overall sensitivity and specificity of the diagnosis of TFCC tear were the same between MRA and MRA with DCA (reader 1, sensitivity 96.4%/96.4% (MRA/MRA with DCA), specificity 68.8%/68.8%, accuracy 86.4%/86.4%, reader 2, sensitivity 96.4%/96.4%, specificity 93.8%/93.8%, accuracy 95.5%/95.5%). For intrinsic ligaments, all diagnostic values were increased on MRA with DCA as compared with MRA for both readers (S-L ligament: reader 1, sensitivity 77.8%/77.8% (MRA/MRA with DCA), specificity 92.3%/96.2%, accuracy 86.4%/88.6%, reader 2, sensitivity 61.1%/61.1%, specificity 76.9%/88.5%, accuracy 70.5%/77.3%, L-T ligament: reader 1, sensitivity 66.7%/100%, specificity 89.7%/89.7%, accuracy 81.8%/93.2%, reader 2, sensitivity 60.0%/86.7%, specificity 82.8%/86.2%, accuracy 75%/86.4%), without statistical significance (p>0.05). The inter-observer agreement was more increased on MRA with DCA than MRA alone.

Wrist MR arthrography with dynamic cine-arthrography resulted in a higher diagnostic value of intrinsic ligament tear and increased the inter-observer agreement of TFCC and intrinsic ligament tear as compared with wrist MR arthrography alone.

The use of wrist MR arthrography plus dynamic cine-arthrography which was performed during contrast injection for MRA, may help increase diagnostic performance for TFCC and intrinsic ligament tear.

Lee, S, Kim, B, Oh, S, Park, J, Ahn, K, Choo, J, Hong, S, Kang, C, Comparison of Wrist MR Arthrography Alone and Wrist MR Arthrography Plus Dynamic Cine-arthrography: The Usefulness in the Diagnosis of Triangular Fibrocartilage Complex and Intrinsic Ligament Tear.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010417.html