High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary?

• Published in: Archives of orthopaedic and trauma surgery Vol. 137; no. 10; pp. 1443 - 1450
• Main Authors: Ochman, Sabine, Wieskötter, B., Langer, M., Vieth, V., Raschke, M. J., Stehling, C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2017; Springer Nature B.V
• Subjects: Arthralgia - diagnostic imaging; Arthralgia - surgery; Arthroscopy; Handsurgery; Humans; Magnetic Resonance Imaging; Medical diagnosis; Medicine; Medicine & Public Health; Orthopedics; Sensitivity and Specificity; Wrist - diagnostic imaging; Wrist - surgery; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery; Wrist; High resolution; Arthroscopy; 3T MRI; MRI
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-017-2747-2

Introduction 3T MRI has become increasingly available for better imaging of interosseous ligaments, TFCC, and avascular necrosis compared with 1.5T MRI. This study assesses the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard. Patients and methods Eighteen patients were examined with 3T MRI using coronal T1-TSE; PD-FS; and coronal, sagittal, and axial contrast-enhanced T1-FFE-FS sequences. Two musculoskeletal radiologists evaluated the images independently. Patients underwent diagnostic arthroscopy. Results The classifications of the cartilage lesions showed good correlations with the arthroscopy findings ( κ  = 0.8–0.9). In contrast to the arthroscopy, cartilage of the distal carpal row was very good and could be evaluated in all patients on MRI. The sensitivity for the TFCC lesion was 83%, and the specificity was 42% (radiologist 1) and 63% (radiologist 2). For the ligament lesions, the sensitivity and specificity were 75 and 100%, respectively, with a high interobserver agreement ( κ  = 0.8–0.9). Discussion 3T MRI proved to be of good value in diagnosing cartilage lesions, especially in the distal carpal row, whereas wrist arthroscopy provided therapeutic options. When evaluating the surgical therapeutical options, 3T MRI is a good diagnostic tool for pre-operatively evaluating the cartilage of the distal carpal row.