RSNA 2014 

Abstract Archives of the RSNA, 2014


SSK14-02

Infective Tenosynovitis: Usefulness of MRI and Ultrasonography

Scientific Papers

Presented on December 3, 2014
Presented as part of SSK14: Musculoskeletal Imaging (Infection and Arthritis)

Participants

Abhishek Jha, Presenter: Nothing to Disclose
Prakhar Gupta, Abstract Co-Author: Nothing to Disclose
Ajay Gupta, Abstract Co-Author: Nothing to Disclose
DEEPAK RAGHAV, Abstract Co-Author: Nothing to Disclose
Sanjog Tewari, Abstract Co-Author: Nothing to Disclose
Ibne Ahmad MBBS, MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

(1) To describe the MRI findings in infective tenosynovitis of the upper extremity. (2) To compare the sensitivity of MRI with ultrasonography in the diagnosis of tenosynovitis.  

METHOD AND MATERIALS

This prospective study consisted of 60 patients with clinical features suggestive of tenosynovitis presenting to OPD of Orthopedic surgery. Children under 4 years of age were excluded from the study owing to technical limitations associated with sedation. After clinical evaluation these patients underwent ultrasonography and MRI of the affected part. Ultrasonography and MRI were performed and interpreted by 2 separate radiologists. Thereafter, these patients underwent fine needle aspiration cytology from the affected part. The sensitivity of both the imaging modalities were then calculated and compared with the cytopathological findings.

RESULTS

Out of 60 patients included in study, 45 were found to have infective tenosynovitis on cytopatholgy. MRI was highly sensitive in the diagnosis of infective tenosynovitis. On MRI, Infective tenosynovitis involved flexor digitorum superficialis in 17 cases, flexor digitorum profundus in 13 cases and extensor carpi ulnaris in 5 cases each and multiple flexor tendons were involved in 10 cases. The most consistent finding of infective tenosynovitis on MRI was altered signal intensity of the tendon sheaths, which was seen in 43 cases, followed by abnormal tendon enhancement and fluid around tendon sheaths which were seen in 33 cases. Ultrasound detected the condition in 29 cases, where 22 cases showed fluid around and tendon and 4 cases showed hypoechoic tendon thickening and 3 case showed both the findings. The overall sensitivity, specificity, positive predictive value and negative predictive value of MRI examination was found to be 95.5%, 93.3%, 97.7% and 87.5%, respectively, while the same parameters for ultrasound were 64.4%, 66.6%, 85.3% and 38.4%.

CONCLUSION

MRI is highly accurate in diagnosis of tenosynovitis and associated complications, while ultrasonography can be used as a preliminary investigation in emergency situations.

CLINICAL RELEVANCE/APPLICATION

In patients with suspected infective tenosynovitis, MRI is a highly useful non invasive tool with excellent accuracy which also provides collateral information about the management of these patients.

Cite This Abstract

Jha, A, Gupta, P, Gupta, A, RAGHAV, D, Tewari, S, Ahmad, I, Infective Tenosynovitis: Usefulness of MRI and Ultrasonography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015115.html