Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea.
Am J Emerg Med. 2018 May;36(5):859-864. doi: 10.1016/j.ajem.2018.01.005. Epub 2018 Jan 4.
We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow.
A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers.
Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2-99.1%), specificity (96.8-97.3%), and accuracy (96.9-97.9%); these diagnostic performance values did not differ significantly between reviewers (p=0.58-0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC=0.964; musculoskeletal radiology fellow, ICC=0.976), as was the inter-observer agreement (ICC=0.968).
Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.
我们评估了即时腕关节超声与 3T 磁共振成像（MRI）在诊断尺侧疼痛伴不稳定的创伤患者三角纤维软骨复合体（TFCC）损伤方面的有效性。此外，我们评估了急诊医师和肌肉骨骼放射科医师之间的观察者间变异性。
前瞻性横断面研究在急诊科进行；招募了尺侧扭伤伴不稳定的患者。急诊医师和肌肉骨骼放射科医师分别使用即时腕关节超声评估 TFCC、半月板同源物、掌侧和背侧远端桡尺韧带以及尺侧腕伸肌。结果分为正常、部分撕裂或完全撕裂。腕 3T-MRI 用作参考标准。我们使用 DeLong 检验比较了两位观察者的即时超声诊断值。计算了每位观察者与参考标准之间以及两位观察者之间的一致性的组内相关系数（ICC）。
共纳入 65 例患者。即时腕关节超声检查显示出可接受的敏感性（97.2-99.1%）、特异性（96.8-97.3%）和准确性（96.9-97.9%）；这些诊断性能值在观察者之间没有显著差异（p=0.58-0.98）。每位观察者与参考标准之间的一致性均为极好（急诊医师，ICC=0.964；肌肉骨骼放射科医师，ICC=0.976），观察者间一致性也很好（ICC=0.968）。
即时腕关节超声与 MRI 一样精确，可以检测 TFCC 损伤，并可用于即时诊断和进一步的术前成像。此外，它可以缩短从急诊科就诊到手术干预的时间间隔，同时降低成本。
