Haims Andrew H, Schweitzer Mark E, Morrison William B, Deely Diane, Lange Robert, Osterman A Lee, Bednar John M, Taras John S, Culp Randall W
Department of Radiology, Yale University School of Medicine, 333 Cedar St., P. O. Box 208042, New Haven, CT 06520-8042, USA.
AJR Am J Roentgenol. 2002 Feb;178(2):419-22. doi: 10.2214/ajr.178.2.1780419.
The treatment of peripheral tears of the triangular fibrocartilage complex is radically different from the more typical central, degenerative tears. To our knowledge, no reports in the imaging literature specifically evaluate tears of the ulnar attachment of the triangular fibrocartilage complex. We evaluated the accuracy of MR imaging in these patients.
Eighty-six MR imaging examinations of the wrist (41 indirect MR arthrograms and 45 unenhanced MR images) were evaluated: 20 wrists with surgically confirmed peripheral triangular fibrocartilage complex tears and 66 wrists with surgically documented normal ulnar attachment. These cases were evaluated by three experienced musculoskeletal radiologists, who were unaware of the surgical findings, to assess the presence of peripheral triangular fibrocartilage complex tears or fluid signal at the ulnar attachment of the triangular fibrocartilage complex.
The sensitivity for evaluation of the peripheral triangular fibrocartilage complex tear was 17%, with a specificity of 79% and an accuracy of 64%. High signal intensity at the ulnar insertion of the triangular fibrocartilage complex as a marker for tear showed a sensitivity of 42%, a specificity of 63%, and an accuracy of 55%. Weighted kappa values revealed only fair agreement among the three observers.
MR imaging does not adequately reveal the peripheral attachment of the triangular fibrocartilage complex.
三角纤维软骨复合体周边撕裂的治疗与更典型的中央退行性撕裂截然不同。据我们所知，影像学文献中尚无专门评估三角纤维软骨复合体尺侧附着处撕裂的报道。我们评估了磁共振成像（MR成像）对这些患者的诊断准确性。
对86例腕部MR成像检查（41例间接MR关节造影和45例未增强MR图像）进行评估：20例经手术证实为三角纤维软骨复合体周边撕裂的腕部，以及66例经手术记录尺侧附着正常的腕部。由三位经验丰富的肌肉骨骼放射科医生对这些病例进行评估，他们不知道手术结果，以评估三角纤维软骨复合体周边撕裂或三角纤维软骨复合体尺侧附着处的液体信号是否存在。
评估三角纤维软骨复合体周边撕裂的敏感性为17%，特异性为79%，准确性为64%。三角纤维软骨复合体尺侧附着处的高信号强度作为撕裂的标志物，敏感性为42%，特异性为63%，准确性为55%。加权kappa值显示三位观察者之间只有中等程度的一致性。
MR成像不能充分显示三角纤维软骨复合体的周边附着情况。
