Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population

Overview

Journal Indian J Orthop

Publisher Springer Nature

Specialty Orthopedics

Date 2019 Nov 2

PMID 31673180

Citations 2

Authors

Nishank H Mehta

Bhavuk Garg

Tahir Ansari

Deep N Srivastava

Prakash P Kotwal

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain.

Materials And Methods: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures - triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL).

Results: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%.

Conclusions: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.

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References

Nelson D . The importance of the physical examination. Hand Clin. 1997; 13(1):13-5. View

Metz V, Mann F, Gilula L . Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography. AJR Am J Roentgenol. 1993; 160(6):1239-43. DOI: 10.2214/ajr.160.6.8498225. View

Scheck R, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K . The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging. 1999; 9(3):468-74. DOI: 10.1002/(sici)1522-2586(199903)9:3<468::aid-jmri16>3.0.co;2-t. View

Chen Y . Arthroscopy of the wrist and finger joints. Orthop Clin North Am. 1979; 10(3):723-33. View

Lee R, Griffith J, Ng A, Nung R, Yeung D . Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage. AJR Am J Roentgenol. 2015; 206(1):155-61. DOI: 10.2214/AJR.15.14948. View

Herbert T, Faithfull R, McCann D, Ireland J . Bilateral arthrography of the wrist. J Hand Surg Br. 1990; 15(2):233-5. DOI: 10.1016/0266-7681_90_90129-r. View

Kelly E, Stanley J . Arthroscopy of the wrist. J Hand Surg Br. 1990; 15(2):236-42. DOI: 10.1016/0266-7681_90_90130-v. View

Mohamadi A, Claessen F, Ozkan S, Kolovich G, Ring D, Chen N . Diagnostic Wrist Arthroscopy for Nonspecific Wrist Pain. Hand (N Y). 2017; 12(2):193-196. PMC: 5349414. DOI: 10.1177/1558944716661993. View

Ruegger C, Schmid M, Pfirrmann C, Nagy L, Gilula L, Zanetti M . Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol. 2006; 188(1):187-92. DOI: 10.2214/AJR.05.2056. View

10.

Adolfsson L . Arthroscopy for the diagnosis of post-traumatic wrist pain. J Hand Surg Br. 1992; 17(1):46-50. DOI: 10.1016/0266-7681(92)90010-y. View

11.

North E, Meyer S . Wrist injuries: correlation of clinical and arthroscopic findings. J Hand Surg Am. 1990; 15(6):915-20. DOI: 10.1016/0363-5023(90)90015-j. View

12.

Zanetti M, Bram J, Hodler J . Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI?. J Magn Reson Imaging. 1997; 7(3):590-4. DOI: 10.1002/jmri.1880070322. View

13.

Morley J, Bidwell J, Bransby-Zachary M . A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain. J Hand Surg Br. 2002; 26(6):544-6. DOI: 10.1054/jhsb.2001.0645. View

14.

Zlatkin M, Chao P, Osterman A, SCHNALL M, Dalinka M, Kressel H . Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology. 1989; 173(3):723-9. DOI: 10.1148/radiology.173.3.2813777. View

15.

Lenk S, Ludescher B, Martirosan P, Schick F, Claussen C, Schlemmer H . 3.0 T high-resolution MR imaging of carpal ligaments and TFCC. Rofo. 2004; 176(5):664-7. DOI: 10.1055/s-2004-813112. View

16.

Mahmood A, Fountain J, Vasireddy N, Waseem M . Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding?. Open Orthop J. 2012; 6:194-8. PMC: 3367475. DOI: 10.2174/1874325001206010194. View

17.

Andersson J, Andernord D, Karlsson J, Friden J . Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review. Arthroscopy. 2015; 31(10):2014-20.e2. DOI: 10.1016/j.arthro.2015.04.090. View

18.

Meier R, Schmitt R, Krimmer H . [Wrist lesions in MRI arthrography compared with wrist arthroscopy]. Handchir Mikrochir Plast Chir. 2005; 37(2):85-9. DOI: 10.1055/s-2004-830376. View

19.

Brown D, Lichtman D . The evaluation of chronic wrist pain. Orthop Clin North Am. 1984; 15(2):183-92. View

20.

Saupe N, Prussmann K, Luechinger R, Bosiger P, Marincek B, Weishaupt D . MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging--preliminary experience. Radiology. 2004; 234(1):256-64. DOI: 10.1148/radiol.2341031596. View