Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Eur Radiol. 2021 Dec;31(12):9399-9407. doi: 10.1007/s00330-021-08024-3. Epub 2021 May 18.
Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist.
Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated.
Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers' confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting.
Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions.
• In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex. • Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions. • Additional radial planes provide greater diagnostic confidence.
三角纤维软骨复合体（TFCC）损伤常导致尺侧腕部疼痛，并可引起下尺桡关节不稳定。由于其复杂的三维结构，即使在磁共振关节造影术中，TFCC 病变的诊断仍然是一项具有挑战性的任务。本研究的目的是评估与腕关节直接造影后标准平面相比，各向同性 3D MRI 数据集的放射状重建成像对 TFCC 损伤的附加诊断价值。
93 例患者在透视引导下多关节造影后行腕关节 MRI 检查。两名放射科医生共同分析了每个磁共振关节造影的两组数据集，一组包含 3D 薄层序列的轴向、冠状和矢状位标准重建，另一组包含附加的放射状平面视图，旋转中心位于尺骨茎突。手术报告（如有）或放射学报告结合临床随访作为参考标准。此外，还对中央盘和尺侧插入物的诊断信心和可评估性进行了主观评估。
关节盘、茎突和窝状尺侧附着处的损伤分别见于 20（23.7%）、10（10.8%）和 9（9.7%）例患者。附加的放射状平面提高了对茎突（0.83 对 0.90；p=0.016）和窝状尺侧附着处（0.86 对 0.94；p=0.039）病变的诊断准确性，而对中央软骨盘的改变则没有改善。附加放射状重建成像可提高读者对尺侧插入物的信心（p<0.001）和可评估性（p<0.001）。
磁共振关节造影术中获得各向同性 3D 序列的放射状平面视图可提高尺侧 TFCC 病变的诊断准确性和信心。
在腕关节多关节造影术中，辅助放射状平面视图有助于评估三角纤维软骨复合体的窝状和尺侧茎突插入物。
获得放射状多平面重建可更准确地评估外周 TFCC 损伤。
附加的放射状平面可提供更大的诊断信心。
