Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany.
Eur J Radiol. 2021 Oct;143:109901. doi: 10.1016/j.ejrad.2021.109901. Epub 2021 Aug 10.
Although lesions of the triangular fibrocartilage complex (TFCC) frequently induce ulnar-sided wrist pain and potentially distal radioulnar joint instability, diagnosis can pose a challenge due to the intricate anatomy. This study aims to evaluate the benefits of contrast-enhanced sequences for the detection of TFCC injuries in magnetic resonance imaging of the wrist.
94 patients underwent wrist MRI with intravenous application of gadolinium-based contrast agents. For each patient, two datasets were analysed independently by two board-certified radiologists: One set comprised only plain T1- and fat-saturated proton-density-weighted sequences, while the second dataset included contrast-enhanced T1-weighted images with fat suppression. Arthroscopy or clinical reports served as reference standard with the former being used whenever available. Diagnostic confidence and TFCC component assessability were subjectively evaluated. Contrast-to-noise ratios (CNR) were calculated serve as an objective indicator of image contrast.
Lesions of the articular disc, the foveal and styloid ulnar attachment were present in 24 (25.5%), 61 (64.9%) and 53 (56.4%) patients. Access to contrast-enhanced T1 images improved the diagnostic accuracy for injuries of the styloid (R1/R2, 0.68/0.73 vs. 0.86/0.88) and foveal attachment (0.68/0.72 vs. 0.90/0.89) substantially compared to plain MRI (all p < 0.001), while no benefits could be identified for lesions of the central disc (0.89/0.90 vs. 0.87/0.90). Readers' diagnostic confidence and CNR for ulnar-sided lesions improved with contrast-enhanced T1 sequences available (p < 0.001).
With superior CNR in lesions of the TFCC's foveal and styloid attachment, contrast-enhanced, fat-saturated T1-weighted sequences facilitate higher diagnostic accuracy and confidence than fat-saturated PD- and plain T1-weighted MRI.
尽管三角纤维软骨复合体（TFCC）的病变常引起尺侧腕部疼痛，并可能导致远侧桡尺关节不稳定，但由于其复杂的解剖结构，诊断可能具有挑战性。本研究旨在评估对比增强序列在腕关节磁共振成像中检测 TFCC 损伤的益处。
94 例患者行腕关节 MRI 检查，静脉注射钆基对比剂。对于每位患者，由两名具有委员会认证的放射科医生独立分析两组数据集：一组仅包括平扫 T1 加权和脂肪饱和质子密度加权序列，另一组包括对比增强 T1 加权图像，采用脂肪抑制。以前者作为参考标准，只要可行，均采用关节镜或临床报告。主观评估诊断信心和 TFCC 成分可评估性。计算对比噪声比（CNR）作为图像对比度的客观指标。
关节盘、窝状和尺骨茎突附着处的病变分别存在于 24（25.5%）、61（64.9%）和 53（56.4%）例患者中。与平扫 MRI 相比，使用对比增强 T1 图像可显著提高尺骨侧（R1/R2，0.68/0.73 与 0.86/0.88）和窝状附着处（0.68/0.72 与 0.90/0.89）损伤的诊断准确性（均 p<0.001），而对中央盘病变无明显获益（0.89/0.90 与 0.87/0.90）。读者的诊断信心和 CNR 随着对比增强 T1 序列的应用而提高（p<0.001）。
在 TFCC 的窝状和尺骨茎突附着处病变中，具有更高的 CNR，对比增强、脂肪饱和 T1 加权序列比脂肪饱和 PD 和平扫 T1 加权 MRI 更能提高诊断准确性和信心。
