Thomsen N O B, Besjakov J, Björkman A
Department of Clinical Sciences Malmö -Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Radiology, Skåne University Hospital, Malmö, Sweden.
J Wrist Surg. 2018 Nov;7(5):382-388. doi: 10.1055/s-0038-1661419. Epub 2018 Jun 26.
Magnetic resonance (MR) is the most important imaging technique to assess intra-articular pathology of the wrist. Among various MR imaging protocols, the diagnostic performance of indirect MR arthrography needs further investigation. The purpose of this study was to assess the diagnostic performance of pre- and postcontrast, 3 T indirect MR arthrography in the diagnosis of scapholunate intrinsic ligament (SLIL) and triangular fibrocartilage complex (TFCC) injuries, using wrist arthroscopy as reference standard. We retrospectively evaluated consecutive patients with suspected SLIL or TFCC injury, who had indirect MR arthrography done before arthroscopy. Images were assessed independently by two senior radiologists. Arthroscopy of the 53 wrists demonstrated 16 Geissler stages II and III partial tears and 6 stage IV total SLIL ruptures. Central perforation of the TFCC was found in 24 wrists, and 12 wrists had an ulnar class 1B lesion. To detect any SLIL tear, accuracy was higher for the two observers using postcontrast indirect MR arthrography (0.77 and 0.72) than for precontrast MR imaging (0.60 and 0.60). No difference was found for total SLIL ruptures "0.85 and 0.89" versus "0.85 and 0.89." To diagnose class 1B TFCC injuries, accuracy was higher using postcontrast indirect MR arthrography (0.85 and 0.75) than for precontrast MR imaging (0.70 and 0.72). No difference in accuracy was demonstrated for TFCC central tears "0.75 and 0.75" versus "0.70 and 0.77." Postcontrast images at 3 T indirect MR arthrography, compared with precontrast images, have an improved diagnostic performance for the overall detection of SLIL injuries and as well as class 1B TFCC tears. This is a Level II, diagnostic study.
磁共振成像（MR）是评估腕关节内病变最重要的成像技术。在各种MR成像方案中，间接MR关节造影的诊断性能需要进一步研究。
本研究的目的是以腕关节镜检查为参考标准，评估3T间接MR关节造影术前和术后对舟月骨间韧带（SLIL）和三角纤维软骨复合体（TFCC）损伤的诊断性能。
我们回顾性评估了连续的疑似SLIL或TFCC损伤且在关节镜检查前行间接MR关节造影的患者。图像由两名资深放射科医生独立评估。
53例腕关节的关节镜检查显示16例Geissler II期和III期部分撕裂以及6例IV期SLIL完全断裂。24例腕关节发现TFCC中央穿孔，12例腕关节有尺侧1B级损伤。对于两名观察者而言，使用造影剂后间接MR关节造影检测任何SLIL撕裂的准确性（分别为0.77和0.72）高于造影剂前MR成像（分别为0.60和0.60）。对于SLIL完全断裂，“0.85和0.89”与“0.85和0.89”之间未发现差异。对于诊断1B级TFCC损伤，使用造影剂后间接MR关节造影的准确性（分别为0.85和0.75）高于造影剂前MR成像（分别为0.70和0.72）。对于TFCC中央撕裂，“0.75和0.75”与“0.70和0.77”之间在准确性上未显示差异。
3T间接MR关节造影的造影剂后图像与造影剂前图像相比，在SLIL损伤和1B级TFCC撕裂的总体检测方面具有更高的诊断性能。
这是一项II级诊断性研究。
