TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities

Abstract

Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity. This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries. A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the "gold standard." A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries. Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72-0.80), 0.78(0.70-0.84), and 0.89 (0.81-0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77-0.86), 0.85 (0.77-0.92), and 0.89 (0.81-0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions. This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

“…Our results for specificity, sensitivity and accuracy are concordant with a meta-analysis of 28 studies by Treiser et al [37], confirming that overall diagnostic accuracy is generally higher for central compared to peripheral TFCC alterations. However, the detection rate of peripheral TFCC discontinuity was considerably better with the addition of radial plane view and almost reached the diagnostic accuracy for central lesions in this study.…”

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

“…For this reason, we first queried our hospital database for patients who had received wrist arthroscopy at our tertiary referral center. The inclusion criteria were as follows: age under 19 years at the date of surgery, arthroscopically verified and classified TFCC tear according to Palmer [22,25], preoperative presence of a lateral wrist radiograph and an MRI of the affected wrist. The Palmer classification briefly distinguishes between traumatic (type 1) and degenerative tears (type 2).…”

“…The clinical presentation of the patient may be difficult to interpret due to the complex anatomy of the human wrist. Hence, recent reports suggest the use of standardized measurement techniques on patient's radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) as an additional diagnostic tool [17][18][19][20][21][22]. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique [17,23] and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distance on lateral radiographs [24] in children with arthroscopicallyverified TFCC tears.…”

Surgical Repair of Acute TFCC Injury

“…4 A recent meta-analysis of diagnostic imaging in TFCC injuries determined the sensitivity/specificity of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) to be 72% to 80%/77% to 86% and 70% to 84%/77% to 92%, respectively, using either arthroscopic or open surgical findings as the standard. 15 In addition to abnormal signal within the TFCC, MRI may also demonstrate signal within the carpi, which may indicate impaction, and signal within the ECU, which may indicate ECU tendonitis. The most common impaction syndrome is ulnar impaction, also known as ulnar abutment or ulnocarpal loading, and is associated with chronic, degenerative TFCC lesions that occur when the distal ulna affects the carpi, particularly the lunate.…”