Schmitt R, Christopoulos G, Meier R, Coblenz G, Fröhner S, Lanz U, Krimmer H
Institut für Diagnostische und Interventionelle Radiologie der Herz- und Gefässklinik GmbH Bad Neustadt an der Saale.
Rofo. 2003 Jul;175(7):911-9. doi: 10.1055/s-2003-40434.
In literature the diagnostic value of MRI for detecting lesions of the carpal ligaments and the TFCC is judged controversially. The aim of the following study is to determine the diagnostic accuracy of direct MR arthrography for depicting and staging of intraarticular lesions of the wrist.
One day before undergoing arthroscopy, 125 patients suffering from wrist pain were examined with direct MR arthrography in a prospective and blinded study. A mixture of contrast medium (iodine-containing contrast medium and gadopentetate in relation 200 : 1) was injected into both radiocarpal and midcarpal joints. The following sequences were acquired on a 1.5T scanner: coronal T1-weighted SE, coronal fat-saturated T1-weighted SE, coronal T1-/T2*-DESS-3D, and sagittal T2*-weighted MEDIC. MRI results were compared with arthroscopic findings using statistical analysis (SEN = sensitivity, SPE = specificity, PPV = positive predictive value, NPV = negative predictive value, ACC = accuracy).
In comparison to arthroscopy as the accepted diagnostic gold standard, the following results were found for MR arthrography. Detection of TFCC lesions: SEN 97.1 %, SPE 96.4 %, PPV 97.1 %, NPV 96.4 %, ACC 96.8 %. Detection of complete tears of the scapholunate ligament: SEN 91.7 %, SPE 100 %, PPV 100 %, NPV 99.1%, ACC 99.2%. Detection of partial tears: SEN 62.5 %, SPE 100 %, PPV 100 %, NPV 94.8 %, ACC 95.2 %. Detection of cartilage defects: SEN 84.2 %, SPE 96.2 %, PPV 80 %, NPV 97.1 %, ACC 94.4 %. In total, only three lesions of the lunotriquetral ligament were present.
Direct MR arthrographic imaging is well suited for detecting intraarticular lesions of the wrist. The presented diagnostic results of MR arthrography are superior to the results of unenhanced MRI reported in the literature. Direct MR arthrography as a reliable diagnostic tool is strongly recommended if lesions of the scapholunate ligament and the triangular fibrocartilage complex are suspected. In contrast, an attitude of caution must be adopted in diagnosing lesions of the articular cartilage of the wrist.
在文献中，MRI对腕关节韧带和三角纤维软骨复合体（TFCC）损伤的诊断价值存在争议。本研究的目的是确定直接磁共振关节造影术对腕关节内损伤的显示及分期的诊断准确性。
在一项前瞻性双盲研究中，125例腕部疼痛患者在接受关节镜检查前一天接受了直接磁共振关节造影检查。将造影剂混合物（含碘造影剂与钆喷酸葡胺比例为200:1）注入桡腕关节和腕中关节。在1.5T扫描仪上采集以下序列：冠状位T1加权自旋回波（SE）序列、冠状位脂肪抑制T1加权SE序列、冠状位T1/T2双回波稳态进动（DESS）三维序列以及矢状位T2加权MEDIC序列。使用统计分析（SEN = 敏感度，SPE = 特异度，PPV = 阳性预测值，NPV = 阴性预测值，ACC = 准确度）将MRI结果与关节镜检查结果进行比较。
与被公认为诊断金标准的关节镜检查相比，磁共振关节造影术有以下结果。TFCC损伤的检测：敏感度97.1%，特异度96.4%，阳性预测值97.1%，阴性预测值96.4%，准确度96.8%。舟月韧带完全撕裂的检测：敏感度91.7%，特异度100%，阳性预测值100%，阴性预测值99.1%，准确度99.2%。部分撕裂的检测：敏感度62.5%，特异度100%，阳性预测值100%，阴性预测值94.8%，准确度95.2%。软骨缺损的检测：敏感度84.2%，特异度96.2%，阳性预测值80%，阴性预测值97.1%，准确度94.4%。总共仅发现3例月三角韧带损伤。
直接磁共振关节造影成像非常适合检测腕关节内损伤。本文所呈现的磁共振关节造影诊断结果优于文献中报道的未增强MRI结果。如果怀疑存在舟月韧带和三角纤维软骨复合体损伤，强烈推荐将直接磁共振关节造影术作为一种可靠的诊断工具。相比之下，在诊断腕关节软骨损伤时必须采取谨慎态度。
