The Value of 3.0-Tesla MRI in Diagnosing Scapholunate Ligament Injury

Abstract

Diagnosis of a complete scapholunate ligament (SLL) injury is most often largely based on history, clinical examination, and plain radiographs.1-3 Unfortunately, an unequivocal diagnosis cannot always be made because a rupture is partial or because a complete rupture has intact secondary scaphoid stabilizers (the scaphotrapeziotrapezoidal, scaphocapitate, and radioscaphocapitate ligaments). AbstractObjective To determine the sensitivity and specificity of 3.0-tesla (T) magnetic resonance imaging (MRI) and a dedicated hand coil in diagnosing scapholunate ligament (SLL) injury compared with intraoperative findings. Methods From January 2006 until September 2010, 3.0-T MRI scans were performed on 38 wrists (37 patients) with clinically unclear but suspected lesions of the SLL. These scans were evaluated by two experienced radiologists. Radiological findings were compared with intraoperative findings during arthrotomy. Sensitivity, specificity, accuracy, and positive and negative predictive value were calculated. Results An SLL lesion was identified during arthrotomy in 37 wrists. The first radiologist identified an SLL lesion on MRI in 26 wrists, all of which were confirmed intraoperatively. The second radiologist identified SLL lesions in 31 patients; however, intraoperatively it was found that there was no lesion of the ligament in one patient. Sensitivity ranged from 70 to 81% with a specificity of 100% and a positive predictive value of 97 to 100%. Accuracy measured 71 to 79%. Conclusions 3.0-T MRI of the wrist is moderately sensitive and very specific for detection of SLL lesions. However, if there is a high clinical suspicion of an SLL rupture, a 3.0-T MRI does not often have an additional value. Level of Evidence Diagnostic, level II

Advanced imaging of the scapholunate ligamentous complex

“…Spaans et al studied a larger series of 38 wrists with a clinical suspicion of SL complex injury on 3 T MR and reported improved sensitivity rates between 70 and 81 % and a specificity of 100 % for SLIL tears. The results were comparable with the 3 T MRI studies with small series published by Hobby et al [39]. The previous comparative studies were performed on 1.5 T systems.…”

MR Imaging of Wrist Ligaments

“…26 Field strengths from 0.5 T to 1.5 T were included in the analysis, and higher sensitivity and accuracy was achieved whenever T2*-weighted 3D GRE sequences were used, probably because of the thinner slices and higher spatial resolution achievable with this technique. 26 Diagnostic performance studies published since then have generally shown further improved specificity, at or approaching 100% for both SLL and LTL tears at 3 T, 30,33,130,131 or at 1.5 T with intra-articular gadolinium (Tables 2 and 3). 32,35,36,132 The 1 study that had unusually low specificity was the only study that used indirect arthrography via an intravenous injection rather than an intra-articular injection.…”

“…106 In contrast, sensitivity has not significantly improved in more recent noncontrast MR imaging studies, even at 3 T, with sensitivities ranging from 41% to 89% for SLL tears and 22% to 82% for LTL tears, although these studies more commonly include partial tears, making direct comparison difficult ( Table 2). 30,32,33,36,72,130,131 One study that directly compared 1.5 T with 3 T found a statistically insignificant increase in sensitivity for both SLL and LTL tears. 33 Studies including MRA generally report higher sensitivity: 62% to 100% for SLL tears and 50% to 100% for LTL tears ( Table 3).…”

“…26,30,33,130,131 Therefore, MR imaging of interosseous ligaments is a test with a very high positive likelihood ratio, and a moderately low negative likelihood ratio. Such a test is expected to be more useful when positive, because it is Abbreviation: NA, not available.…”

Open Treatment of Acute Scapholunate Instability

“…[21][22][23][24][25] Lowerresolution MRI scans, however, often do not provide enough information to diagnose carpal ligament lesions. [26][27][28] Depending on the surgeon's preference, diagnostic arthroscopy also can be used if the diagnosis remains in question.…”