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3T MRI of wrist ligaments using true plane oblique 3d T2 Dual Echo Steady State (DESS) – comparison with arthroscopy
EP34367
Poster Title: 3T MRI of wrist ligaments using true plane oblique 3d T2 Dual Echo Steady State (DESS) – comparison with arthroscopy
Submitted on 30 Oct 2020
Author(s): Sondos Eladawi, Steve Amerasekera, Sharon Balamoody, Surabhi Choudhary
Affiliations: Queen Elizabeth Hospital Birmingham- University Hospital Birmingham NHS foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 26
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Poster Information
Abstract: MRI has made direct visualization and assessment of intrinsic wrist ligaments possible following wrist trauma, when scaphoid fracture or ligamentous injury is suspected. This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3d T2 DESS, in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex(TFCC), using arthroscopy as gold standard.
In a retrospective cohort review, patients who underwent wrist arthroscopy over 2 years(n=56) were identified from the database. Dedicated true plane axial and coronal reformats were obtained from 3d T2 DESS sequence for assessing intrinsic ligaments and TFCC. At arthroscopy, tears were classified using Geissler’s classification and compared to MRI findings.
The sensitivity of unenhanced 3T MRI in detecting and characterizing scapholunate ligament tears was 86% and specificity was 82%, with a negative predictive value of 95%. The lunate triquetral ligament was assessed with a high sensitivity(100%) and specificity(95%), with a negative predictive value of 100%. Triangular fibrocartilage tears were assessed with a sensitivity of 95% and negative predictive value of 91%. The overall accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 84%.
3T wrist MRI with dedicated reformats from 3d T2 DESS have a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3d T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of over 95% can lead to reduced need for diagnostic arthroscopy of the wrist.
Summary: We compared the diagnostic value of 3T MRI with dedicated wrist coils to that of wrist arthroscopy.References: 1.Andersson JK, 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 Oct;31(10):2014-20.e2.
2.Geissler WB. Arthroscopic management of scapholunate instability. J Wrist Surg. 2013 May; 2(2): 129–135. doi: 10.1055/s-0033-1343354
3.Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 2009;192(1):80-85. doi:10.2214/AJR.08.1089.
4.Ochman S, Wieskötter B, Langer M, Vieth V, Raschke MJ, Stehling C. High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary?. Arch Orthop Trauma Surg. 2017;137(10):1443-1450. doi:10.1007/s00402-017-2747-2
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