Accuracy of Pre- and Postcontrast, 3 T Indirect MR Arthrography Compared with Wrist Arthroscopy in the Diagnosis of Wrist Ligament Injuries

Abstract

Background Magnetic resonance (MR) is the most important imaging technique to assess intra-articular pathology of the wrist. Among various MR imaging protocols, the diagnostic performance of indirect MR arthrography needs further investigation. Purpose The purpose of this study was to assess the diagnostic performance of pre- and postcontrast, 3 T indirect MR arthrography in the diagnosis of scapholunate intrinsic ligament (SLIL) and triangular fibrocartilage complex (TFCC) injuries, using wrist arthroscopy as reference standard. Patients and Methods We retrospectively evaluated consecutive patients with suspected SLIL or TFCC injury, who had indirect MR arthrography done before arthroscopy. Images were assessed independently by two senior radiologists. Results Arthroscopy of the 53 wrists demonstrated 16 Geissler stages II and III partial tears and 6 stage IV total SLIL ruptures. Central perforation of the TFCC was found in 24 wrists, and 12 wrists had an ulnar class 1B lesion. To detect any SLIL tear, accuracy was higher for the two observers using postcontrast indirect MR arthrography (0.77 and 0.72) than for precontrast MR imaging (0.60 and 0.60). No difference was found for total SLIL ruptures "0.85 and 0.89" versus "0.85 and 0.89." To diagnose class 1B TFCC injuries, accuracy was higher using postcontrast indirect MR arthrography (0.85 and 0.75) than for precontrast MR imaging (0.70 and 0.72). No difference in accuracy was demonstrated for TFCC central tears "0.75 and 0.75" versus "0.70 and 0.77." Conclusion Postcontrast images at 3 T indirect MR arthrography, compared with precontrast images, have an improved diagnostic performance for the overall detection of SLIL injuries and as well as class 1B TFCC tears. Level of Evidence This is a Level II, diagnostic study.

Keywords: MR imaging; arthroscopy; diagnostic performance; indirect MR arthrography; scapholunate ligament; triangular fibrocartilage complex; wrist.

Fig. 1

The precontrast STIR coronal image shows a tear in the proximal part of the scapholunate interosseous ligament (arrow head) ( A ), which becomes evident on the T1-weighted, fat saturated, postcontrast indirect MR arthrography (arrow) ( B ). The axial T1-weighted, precontrast image for the same patient shows the dorsal part of scapholunate interosseous ligament (arrow head) ( C ), while the dorsal part (short arrow) as well as the volar part (long arrow) of the scapholunate interosseous ligament appears distinctly on the T1-weighted, fat saturated, postcontrast indirect MR arthrography ( D ). MR, magnetic resonance; STIR, short tau inversion recovery.

Fig. 2

The precontrast, coronal T1-weighted image suggests ulnar peripheral TFCC pathology (arrow) ( A ). The presence of a class 1B TFCC tear (arrow) is more clearly demonstrated on the postcontrast, T1-weighted, fat saturated, indirect MR arthrography ( B ). MR, magnetic resonance; TFCC, triangular fibrocartilage complex.