Tanaka Toshikazu, Yoshioka Hiroshi, Ueno Teruko, Shindo Masashi, Ochiai Naoyuki
Department of Orthopedic Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan.
J Hand Surg Am. 2006 Oct;31(8):1308-14. doi: 10.1016/j.jhsa.2006.05.001.
To determine whether high-resolution magnetic resonance imaging (MRI) could detect injuries to the triangular fibrocartilage complex (TFCC).
Eleven patients who showed both a positive sign during the ulnocarpal stress test and tenderness at the distal end of the ulna had a high-resolution MRI using a 47-mm diameter microscopy coil. Six regions of the TFCC were investigated for injury: the radial attachment, disc, ulnar attachment of the triangular fibrocartilage (TFC), ulnotriquetral ligament, palmar radioulnar ligament (PRUL), and dorsal radioulnar ligament (DRUL). Arthroscopy was performed subsequently on each patient.
For injuries to the radial attachment or the disc of the TFC, a high-resolution MRI showed 100% sensitivity and 100% specificity compared with arthroscopy. In 3 cases in which injury to the ulnar attachment of the TFC was detected with MRI and examination showed a positive piano-key sign and distal radioulnar joint instability, only 1 injury was confirmed with arthrotomy. For MRI diagnosis of an ulnotriquetral ulnolunate attachment injury, the sensitivity was 100% and the specificity was 70%; however, 3 cases had false-positive results. Finally MRI had 100% sensitivity for detecting DRUL and PRUL injuries, although specificities were 75% and 83%, respectively. With MRI there were 2 false-positive DRUL injury diagnoses and 1 false-positive PRUL injury diagnosis.
High-resolution MRI using a microscopy surface coil allowed assessment of each TFCC component and showed a higher accuracy for diagnosing injuries to the radial attachment and the disc of the TFC compared with previous studies. High-resolution MRI, however, was not able to diagnose DRUL, PRUL, or ulnolunate ligament injuries accurately.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
确定高分辨率磁共振成像（MRI）能否检测三角纤维软骨复合体（TFCC）损伤。
11例尺腕应力试验呈阳性且尺骨远端压痛的患者，使用直径47mm的显微线圈进行高分辨率MRI检查。对TFCC的6个区域进行损伤调查：三角纤维软骨（TFC）的桡侧附着处、盘状部、尺侧附着处、尺三角韧带、掌侧桡尺韧带（PRUL）和背侧桡尺韧带（DRUL）。随后对每位患者进行关节镜检查。
对于TFC桡侧附着处或盘状部损伤，与关节镜检查相比，高分辨率MRI显示敏感性和特异性均为100%。在3例MRI检测到TFC尺侧附着处损伤且检查显示阳性琴键征和桡尺远侧关节不稳定的病例中，只有1例经关节切开术证实有损伤。对于MRI诊断尺三角韧带和尺月韧带附着处损伤，敏感性为100%，特异性为70%；然而，有3例假阳性结果。最后，MRI检测DRUL和PRUL损伤的敏感性均为100%，尽管特异性分别为75%和83%。MRI中有2例假阳性DRUL损伤诊断和1例假阳性PRUL损伤诊断。
使用显微表面线圈的高分辨率MRI能够评估TFCC的每个组成部分，与先前研究相比，对TFC桡侧附着处和盘状部损伤的诊断准确性更高。然而，高分辨率MRI无法准确诊断DRUL、PRUL或尺月韧带损伤。
研究类型/证据水平：诊断性III级。
