Oh Eunsun, Yoon Young C, Park Min J
1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2 Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2017 Mar;90(1071):20160867. doi: 10.1259/bjr.20160867. Epub 2017 Feb 15.
To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears.
26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated.
Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent.
In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T weighted FSE D-MRA and that of 2D T weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T weighted FSE D-MRA has potential for substituting 2D imaging.
比较直接腕关节磁共振关节造影（D-MRA）与二维（2D）T加权快速自旋回波（FSE）序列及三维（3D）各向同性T加权FSE序列在检测三角纤维软骨（TFC）中央穿孔、舟月韧带（SLL）和月三角韧带（LTL）撕裂方面的诊断性能。
纳入26例术前行腕关节D-MRA检查并采用2D和3D各向同性T加权FSE序列成像，随后接受关节镜手术的患者。两名阅片者对每个MRI序列进行独立回顾性评估并评分，以确定是否存在TFC中央穿孔、SLL和LTL撕裂。关节镜检查结果作为参考标准。采用受试者操作特征曲线下面积评估诊断性能。计算两种序列诊断损伤的敏感性、特异性和准确性。
关节镜手术发现21例TFC中央穿孔、7例SLL撕裂和3例LTL撕裂。TFC中央穿孔以及SLL和LTL撕裂的2D和3D序列的受试者操作特征曲线下面积值相同或相似（0.667-0.947）。两种序列对各结构损伤诊断的敏感性、特异性和准确性无显著差异（TFC，两位阅片者/两种序列均为90.5/80/88.5%；SLL，两位阅片者的2D序列以及阅片者A的3D序列均为100/89.5/92.3%，阅片者B的3D序列为85.7/89.5/88.5%；LTL，两位阅片者的2D序列均为66.7/1 hundred/96.2%，两位阅片者的3D序列均为33.3/1 hundred/92.3%）。观察者间一致性为中等至优秀。
在腕关节D-MRA中，3D各向同性和2D T加权FSE序列在诊断TFC中央穿孔、SLL和LTL撕裂方面的性能相当。知识进展：3D各向同性T加权FSE D-MRA和2D T加权FSE D-MRA在诊断TFC中央穿孔以及SLL和LTL撕裂方面无显著差异。3D各向同性T加权FSE D-MRA有替代2D成像的潜力。
