Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain

Background:The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain.Materials and Methods:Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL).Results:For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%.Conclusions:The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.

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“…Our results are comparable to the previously reported studies comparing MRI/MRA and arthroscopy in the literature 101112131415161718…”

Section: Resultssupporting

confidence: 91%

Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population

Mehta

Garg

Ansari

et al. 2019

IJOO

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“…Our results of MRA using direct intra-articular contrast injection for central TFCC lesions (showed sensitivity and specificity 100% & 100% respectively) are higher than the indirect (intravenous) wrist MRA results of Haims et al [22] who used 1.5 T scanner and reported sensitivity and specificity in assessment of the central disk of TFCC (83% & 91% respectively). Recently, Asaad et al [15] who used also single radiocarpal injection and a 1.5 T scanner revealed sensitivity and specificity (89% & 91% respectively) for central TFCC lesions being lower when compared to our results which can be attributed to their detection of Full thickness TFCC tears only.…”

Section: Discussioncontrasting

confidence: 87%

“…Our results of MRA for peripheral ulnar TFCC lesions revealed sensitivity and specificity being 100% & 90.9% respectively are superior to those detected by Asaad et al [15] who used single radiocarpal injection and a 1.5 T scanner revealed lower sensitivity and specificity for peripheral ulnar TFCC lesions (83% & 80% respectively). He attributed his lower sensitivity of MRA for peripheral ulnar TFCC tears than central to the more complex anatomy of the peripheral region of the TFCC, and the possibility that associated focal synovitis at the injured ulnar TFCC attachment might impede the passage of contrast [15].…”

Section: Discussioncontrasting

confidence: 77%

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MR arthrography versus conventional MRI and diagnostic arthroscope in patients with chronic wrist pain

Omar

Mahmoud

Saleh

et al. 2019

European Journal of Radiology Open

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Objective To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain. Materials and methods 37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years "mean age 28 years" complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion. Results MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically. Conclusion MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain.

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“…While static SL instability has been a subject of a great attention with diagnosis and treatment options proposed (Asaad et al., 2017; Elgammal and Lukas, 2016; Koehler et al., 2016; Lee et al., 2016; Lindau, 2016; Mathoulin, 2017), dynamic instability of the radial side of the carpus is an area of sparse investigations. No well-agreed treatment plan is established for dynamic instability.…”

Section: Discussionmentioning

confidence: 99%

Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability

Rubensson

Johansson

Adolfsson

2018

J Hand Surg Eur Vol

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Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain

Abstract: III.

Cited by 14 publications

References 29 publications

Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population

Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population

MR arthrography versus conventional MRI and diagnostic arthroscope in patients with chronic wrist pain

Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability

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