Treiser Matthew D, Crawford Kayva, Iorio Matthew L
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, University of Colorado Medical Center, Aurora, Colorado.
J Wrist Surg. 2018 Jul;7(3):267-272. doi: 10.1055/s-0038-1629911. Epub 2018 Feb 14.
Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity. This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries. A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the "gold standard." A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries. Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72-0.80), 0.78(0.70-0.84), and 0.89 (0.81-0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77-0.86), 0.85 (0.77-0.92), and 0.89 (0.81-0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions. This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.
三角纤维软骨复合体（TFCC）的成像仍然具有挑战性，因为没有单一的成像方式能同时具备完美的敏感性和特异性。本研究对之前的多篇文献进行荟萃分析，以指导TFCC损伤诊断中的无创成像选择。进行了文献检索。纳入了比较磁共振成像（MRI）、磁共振关节造影（MRA）以及计算机断层扫描（CT）/计算机断层扫描关节造影（CTA）在评估TFCC损伤时诊断准确性的研究。所有研究均将关节镜检查或开放手术结果作为“金标准”。对MRA、MRI和CT检测TFCC损伤的诊断准确性进行了荟萃分析。初步检索得到2568篇候选文章。随后对研究进行了审查和筛选，最终有28项独立研究（20项MRI、9项MRA、4项CT/CTA，部分研究包含多种模式）纳入定性数据合成分析。在荟萃分析中对原始数据进行汇总后发现，MRI、MRA和CT关节造影检测TFCC损伤的敏感性分别为0.76（0.72 - 0.80）、0.78（0.70 - 0.84）和0.89（0.81 - 0.95），特异性分别为0.82（0.77 - 0.86）、0.85（0.77 - 0.92）和0.89（0.81 - 0.95）。此外，在所有成像模式中，中央TFCC病变的诊断准确性高于周边病变。本研究是迄今为止比较多种成像模式诊断TFCC损伤的最大规模荟萃分析。汇总数据表明，CTA和MRA在诊断TFCC损伤方面具有统计学上等效的敏感性和特异性。中央TFCC损伤的诊断准确性最高。
