Lee Ryan K L, Griffith James F, Ng Alex W H, Nung Ryan C H, Yeung David K W
1 All authors: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Rm 2A061, 2/F, New Extension Block, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
AJR Am J Roentgenol. 2016 Jan;206(1):155-61. doi: 10.2214/AJR.15.14948.
The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments.
A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction.
With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears.
Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.
本研究旨在评估腕关节磁共振关节造影时牵引对关节间隙增宽、软骨显影以及三角纤维软骨复合体（TFCC）和固有韧带撕裂检测的影响。
一项前瞻性研究纳入了39例患者的40个腕关节（25名男性，14名女性；平均年龄35岁）。使用3-T磁共振成像系统在有和没有轴向牵引的情况下进行磁共振关节造影。两名放射科医生独立测量腕关节和腕骨间关节间隙宽度，并对关节软骨显影进行半定量分级。以传统关节造影作为参考标准并达成共识，他们评估TFCC、月三角韧带（LTL）和舟月韧带（SLL）是否存在撕裂。比较牵引前和牵引后撕裂的显影情况。
牵引后，腕关节和腕骨的所有关节间隙均显著增宽（变化范围为0.15 - 1.01 mm；所有p < 0.006）。除桡舟关节间隙外，牵引后所有关节间隙的主观软骨显影均有所改善（所有p ≤ 0.048），桡舟关节间隙在牵引前就显影良好。传统关节造影显示24例TFCC撕裂、7例LTL撕裂和3例SLL撕裂。牵引后TFCC（牵引后98% vs 牵引前83%）、LTL（100% vs 88%）和SLL（100% vs 95%）撕裂检测的准确性有所提高。牵引后，54%的TFCC撕裂、71%的LTL撕裂和66%的SLL撕裂的显影情况有所改善。
轴向牵引的腕关节磁共振关节造影显著提高了关节软骨的显影以及TFCC和固有韧带撕裂的检测及显影情况。结果支持在腕关节磁共振关节造影时更广泛地使用牵引。
