Department of Radiology, Chung Ang University Hospital.
Department of Orthopaedic Surgery, Chung Ang University Hospital.
Br J Radiol. 2019 Oct;92(1102):20190298. doi: 10.1259/bjr.20190298. Epub 2019 Jul 19.
To compare the diagnostic performance of two-compartment wrist CT arthrography of the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography of the radiocarpal joint in depiction of the triangular fibrocartilage tear.
From January 2016 to December 2017, two-compartment CT arthrography of 74 consecutive patients (36 females, 38 males; mean age, 37.2 years) and unicompartment CT arthrography of 51 consecutive patients (18 females, 33 males; mean age, 40.1 years) were obtained. All CT arthrography images were independently and blindly evaluated by two radiologists for the presence of the triangular fibrocartilage tear by grade (partial or full thickness) per its locations: central disc proper, central-peripheral junction, proximal and distal laminae of its ulnar attachment. Fisher's exact test was used for a statistical analysis, and a -value less than 0.05 was considered as significant. The arthroscopic findings of 47 patients (34 patients with two-compartment CT arthrography and 13 patients with unicompartment CT arthrography) were evaluated for calculating sensitivity, specificity, and accuracy.
All partial and full thickness triangular fibrocartilage tears were identified more commonly by their location except for distal laminae on two-compartment CT arthrography than were unicompartment CT arthrography ( = 0.001-0.022). Two-compartment CT arthrography had high sensitivity (90.9-100%) and low specificity (33.3-76.5%) for detecting central disc proper and proximal lamina tears, comparing with unicompartment CT arthrography.
Two-compartment wrist CT arthrography is more helpful for detecting triangular fibrocartilage tears than unicompartment wrist CT arthrography.
It could be important to evaluate the ulnar foveal insertion of the TFCC in clinical practice, which plays the most important role in DRUJ instability and ulnar-sided wrist pain. Two-compartment wrist CTA of the DRUJ and RCJ could improve diagnostic sensitivity in the TFC tear in terms of its location and torn degree over that of unicompartment wrist CTA of the RCJ. Two-compartment wrist CTA of the DRUJ and RCJ may be recommended as a diagnostic imaging, rather than unicompartment wrist CTA of the RCJ, when peripheral foveal tear of TFC is suspected, especially in young patients.
比较双空间腕关节 CT 关节造影术和单空间腕关节 CT 关节造影术在诊断桡尺远侧和桡腕关节三角纤维软骨撕裂中的诊断性能。
本研究回顾性分析了 2016 年 1 月至 2017 年 12 月间 74 例连续患者（36 名女性，38 名男性；平均年龄 37.2 岁）的双空间 CT 关节造影术和 51 例连续患者（18 名女性，33 名男性；平均年龄 40.1 岁）的单空间 CT 关节造影术。所有 CT 关节造影图像均由两位放射科医生独立、盲法评估，根据其位置按等级（部分或完全厚度）评估三角纤维软骨撕裂的存在：中央盘、中央-外周交界处、尺侧附着的近侧和远侧板。采用 Fisher 确切检验进行统计学分析，p 值小于 0.05 认为有统计学意义。对 47 例患者（34 例接受双空间 CT 关节造影术，13 例接受单空间 CT 关节造影术）的关节镜检查结果进行评估，计算敏感性、特异性和准确性。
除了双空间 CT 关节造影术的远侧板外，所有部分和完全厚度的三角纤维软骨撕裂在双空间 CT 关节造影术上根据其位置比单空间 CT 关节造影术更常见（p 值=0.001-0.022）。双空间 CT 关节造影术检测中央盘和近侧板撕裂的敏感性（90.9%-100%）较高，特异性（33.3%-76.5%）较低，与单空间 CT 关节造影术相比。
双空间腕关节 CT 关节造影术比单空间腕关节 CT 关节造影术更有助于检测三角纤维软骨撕裂。
在临床实践中评估 TFCC 的尺凹窝插入处可能很重要，它在 DRUJ 不稳定和尺侧腕痛中起着最重要的作用。双空间腕关节 DRUJ 和 RCJ 的 CTA 可以提高 TFC 撕裂的位置和撕裂程度的诊断敏感性，优于单空间腕关节 RCJ 的 CTA。当怀疑三角纤维软骨的外周凹窝撕裂时，建议使用双空间腕关节 DRUJ 和 RCJ 的 CTA 作为诊断影像学方法，而不是单空间腕关节 RCJ 的 CTA，尤其是在年轻患者中。
