Brennan Caitlin M, Yong Li Yenn, Foley Jon, McKie Scott, Rust Philippa A
Hooper Hand Unit, St John's Hospital, Howden West Road, Livingston, UK.
Department of Radiology, St John's Hospital, Howden West Road, Livingston, UK.
Arch Bone Jt Surg. 2021 Jul;9(4):423-426. doi: 10.22038/abjs.2020.48520.2464.
A retrospective study was conducted to evaluate the role of distal radioulnar joint (DRUJ) effusion in aiding the diagnostic accuracy of central triangular fibrocartilage complex (TFCC) tears on non-contrast MRI.
89 consecutive patients who had undergone wrist arthroscopy for ulna sided wrist pain in our unit were identified and their preoperative imaging reviewed. Two consultant musculoskeletal Radiologists independently reported the presence or absence of a DRUJ effusion and or a TFCC tear. The inter-observer variability was calculated using weighted Kappa tests. Two by two tables were constructed to calculate the sensitivity and specificity of reported TFCC tear or DRUJ effusion on MRI in correctly diagnosing central TFCC tears identified at arthroscopy.
Sensitivity of MRI to report a TFCC tear was 0.56 and specificity was 0.79. Sensitivity increased to 0.89 if either a DRUJ effusion or TFCC tear were seen on MRI. When observed together, the presence of both a DRUJ effusion and a TFCC tear seen on the imaging lead to a sensitivity of 0.74 and PPV of 82% when compared to findings at arthroscopy. In the absence of both DRUJ effusion and TFCC tear, the specificity of MRI increased to 0.92. Agreement by the radiologists on the presence of DRUJ effusion was substantial (k value 0.67) and TFCC tear was moderate (k value 0.58).
The presence of DRUJ effusion on MRI can further improve sensitivity of MRI in diagnosing central TFCC tears. The sensitivity of detecting a central TFCC tear on MRI scan when both a DRUJ effusion and a TFCC tear were seen (0.74) is comparable to rates demonstrated on MRA meta-analysis results (0.78). Furthermore, considering the absence of both a DRUJ effusion and TFCC tear seen on MRI is useful in excluding the presence of a TFCC tear at arthroscopy.
进行一项回顾性研究，以评估桡尺远侧关节（DRUJ）积液在提高非增强磁共振成像（MRI）对中央三角纤维软骨复合体（TFCC）撕裂诊断准确性方面的作用。
确定89例因尺侧腕关节疼痛在本单位接受腕关节镜检查的连续患者，并回顾其术前影像学资料。两位肌肉骨骼放射科顾问医生独立报告是否存在DRUJ积液和/或TFCC撕裂。采用加权Kappa检验计算观察者间的变异性。构建二乘二表，以计算MRI报告的TFCC撕裂或DRUJ积液在正确诊断关节镜检查发现的中央TFCC撕裂方面的敏感性和特异性。
MRI报告TFCC撕裂的敏感性为0.56，特异性为0.79。如果MRI上看到DRUJ积液或TFCC撕裂，敏感性增加到0.89。当同时观察到两者时，与关节镜检查结果相比，成像上同时存在DRUJ积液和TFCC撕裂时，敏感性为0.74，阳性预测值为82%。在没有DRUJ积液和TFCC撕裂的情况下，MRI的特异性增加到0.92。放射科医生对DRUJ积液存在情况的一致性较高（k值为0.67），对TFCC撕裂的一致性为中等（k值为0.58）。
MRI上DRUJ积液的存在可进一步提高MRI诊断中央TFCC撕裂的敏感性。当同时看到DRUJ积液和TFCC撕裂时，MRI扫描检测中央TFCC撕裂的敏感性（0.74）与MRA荟萃分析结果显示的值（0.78）相当。此外，如果MRI上未看到DRUJ积液和TFCC撕裂，有助于排除关节镜检查时TFCC撕裂的存在。
