Meier R, Schmitt R, Christopoulos G, Krimmer H
Klinik für Handchirurgie, Bad Neustadt/Saale.
Unfallchirurg. 2003 Mar;106(3):190-4. doi: 10.1007/s00113-002-0505-5.
In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were examined with direct MR arthrography prospectively. Within 24 hours an arthroscopy of the wrist was performed. With the MR arthrography in 70 patients or 56% of all patients injury of the TFCC was diagnosed. In 65 patients this could be verified arthroscopically. In the remaining 55 patients no TFCC lesion was diagnosed with the MR arthrography. However lesions were found via arthroscopy in three cases,were MRI findings expected an intact TFCC. In the remaining 52 cases the MRT could exclude a lesion of the TFCC correctly. An agreement of the MRT and arthroscopic results could be determined in 93.6% of the cases (correlation). The diagnosis of a TFCC lesion by means of MRI was correct in 94% of the cases (sensitivity), the exclusion of such lesion in 89% (specificity). Positive or negative predictive values of 91% or 93% were achieved. Since neither a specificity nor a sensitivity of 100% can be reached at the moment, the MR arthrography cannot replace the arthroscopy. However it could be a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate the diagnostics and the indication for surgery at the ulnocarpal wrist and help to reduce arthroscopic interventions that are only for diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect further increase of accuracy and the clinical use of the MR arthrography in the diagnostic workup at the ulnocarpal wrist.
在2000年1月至7月进行的一项双盲研究中，对125例有手腕特定症状的患者进行了前瞻性直接磁共振关节造影检查。在24小时内对手腕进行了关节镜检查。通过磁共振关节造影，在70例患者（占所有患者的56%）中诊断出三角纤维软骨复合体（TFCC）损伤。其中65例经关节镜检查得到证实。在其余55例患者中，磁共振关节造影未诊断出TFCC损伤。然而，在3例患者中通过关节镜检查发现了病变，而磁共振成像结果显示TFCC完整。在其余52例中，磁共振成像正确排除了TFCC损伤。在93.6%的病例中（相关性）可确定磁共振成像与关节镜检查结果一致。通过磁共振成像诊断TFCC损伤的正确率为94%（敏感性），排除此类损伤的正确率为89%（特异性）。阳性或阴性预测值分别为91%或93%。由于目前无法达到100%的特异性和敏感性，磁共振关节造影不能替代关节镜检查。然而，如果使用关节内造影剂，它可能成为手腕诊断的有力辅助工具。它可以促进诊断以及尺腕关节手术的指征判断，并有助于减少仅用于诊断目的且无任何治疗效果的关节镜干预。随着磁共振断层扫描技术的改进，我们预计磁共振关节造影在尺腕关节诊断检查中的准确性和临床应用将进一步提高。
