3T MRI could eliminate need for invasive wrist arthroscopy
MRI of the wrist at 3T is an effective way to detect wrist ligament tears and in some cases can avoid unnecessary surgery, according to a study published in the January issue of the American Journal of Roentgenology.
For the study, performed at Neuroskeletal Imaging in Merritt Island, Fla., MR wrist images in 300 consecutive patients underwent consensus review by two radiologists without knowledge of arthroscopy findings. Forty-nine of 300 patients underwent arthroscopy. Thirty-five of these 49 patients also underwent MR arthrography. Scans were assessed for full-thickness scapholunate, lunatotriquetral or TFCC tears. After consensus review of MR images, arthroscopy results were compared with MR interpretations.
Of the 49 patients who underwent arthroscopy, 22 had TFCC tears, 18 had scapholunate tears and 11 had lunatotriquetral tears (51 total tears at arthroscopy). Nineteen of 22 TFCC tears, 16 of 18 scapholunate tears and nine of 11 lunatotriquetral tears seen at arthroscopy were seen on MRI. Four patients had both a TFCC tear and a lunatotriquetral ligament tear. One patient had a scapholunate ligament tear and a TFCC tear.
There were no false-positive readings on MRI compared with arthroscopy. MR sensitivity for detection of TFCC tears was 86 percent, for detection of scapholunate tears was 89 percent, and for detection of lunatotriquetral tears was 82 percent. MR specificity for detection of tears was 100 percent. MR arthrography sensitivity for detection of ligament and TFCC tears was 100 percent. There were three patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients underwent arthroscopy with no tears seen, according to the authors.
"3T MRI is beneficial to both the patient and the physician. If there is a problem, it provides a road map for the physician to use during surgery and eliminates any type of surgery for those who have normal findings," said Thomas Magee, MD, lead author of the study. "We are able to see bone bruises, cysts and other things that may be pain generators instead of ligament tears.”
Magee and colleagues concluded that MRI at 3T is sensitive and specific for detection of wrist ligament tears. “MR arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations,” they wrote.
For the study, performed at Neuroskeletal Imaging in Merritt Island, Fla., MR wrist images in 300 consecutive patients underwent consensus review by two radiologists without knowledge of arthroscopy findings. Forty-nine of 300 patients underwent arthroscopy. Thirty-five of these 49 patients also underwent MR arthrography. Scans were assessed for full-thickness scapholunate, lunatotriquetral or TFCC tears. After consensus review of MR images, arthroscopy results were compared with MR interpretations.
Of the 49 patients who underwent arthroscopy, 22 had TFCC tears, 18 had scapholunate tears and 11 had lunatotriquetral tears (51 total tears at arthroscopy). Nineteen of 22 TFCC tears, 16 of 18 scapholunate tears and nine of 11 lunatotriquetral tears seen at arthroscopy were seen on MRI. Four patients had both a TFCC tear and a lunatotriquetral ligament tear. One patient had a scapholunate ligament tear and a TFCC tear.
There were no false-positive readings on MRI compared with arthroscopy. MR sensitivity for detection of TFCC tears was 86 percent, for detection of scapholunate tears was 89 percent, and for detection of lunatotriquetral tears was 82 percent. MR specificity for detection of tears was 100 percent. MR arthrography sensitivity for detection of ligament and TFCC tears was 100 percent. There were three patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients underwent arthroscopy with no tears seen, according to the authors.
"3T MRI is beneficial to both the patient and the physician. If there is a problem, it provides a road map for the physician to use during surgery and eliminates any type of surgery for those who have normal findings," said Thomas Magee, MD, lead author of the study. "We are able to see bone bruises, cysts and other things that may be pain generators instead of ligament tears.”
Magee and colleagues concluded that MRI at 3T is sensitive and specific for detection of wrist ligament tears. “MR arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations,” they wrote.