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Comparison of MRI, Arthrography and Arthroscopy in Diagnosing TFCC Injury
Koji Abe, MD; Toshiyasu Nakamura, MD; PhD
Clinical Research Center, International University of Health and Welfare, Tokyo, Japan

Introduction: Radiocarpal (RC) arthroscopic findings have already been compared with MRI and/or arteriogram (AG) for its diagnostic ability of TFCC injury. Recently introduced distal radio-ulnar joint (DRUJ) arthroscopy has advanced diagnostic ability of arthroscopy for TFCC injuries. The purpose of this study was to compare the diagnosing ability of both RC and DRUJ arthroscopies with preoperative MRI and arthrogram on peripheral TFCC injuries.

Materials & Methods: We retrospectively reviewed 140 consecutive TFCC injury patients. All patients underwent MRI (1.5T, Fat suppression T1WI, GRE T2*WI) and arthrogram (die into the RC joint, DRUJ) preoperatively, then RC and DRUJ arthroscopy was performed. We used Palmer's classification for RC joint findings and evaluated whether the fovea avulsion of the radioulnar ligament existed on DRUJ arthroscopy or not. We examined the sensitivity, specificity and accuracy of MRI and arthrogram for diagnosis of peripheral TFCC injuries (1B tear and foveal avulsion) compared with those of RC and DRUJ arthroscopic findings.

Results: RC arthroscopy demonstrated that there were 1A tear in 16, 1B tear in 107, 1C tear in 1, and Class 2 in 30. DRUJ arthroscopy revealed 32 fovea avulsion. MRI demonstrated no 1A, 1B in 44, no 1C and Class 2 in 4 and AG demonstrated 1A in 11, 1B in 103, no 1C and Class 2 in 5. MRI indicated fovea avulsion in 84 wrists, while AG in 44, respectively. For the diagnosis of 1B peripheral tear, the sensitivity, specificity and accuracy of MRI and arthrogram were 39% / 93% / 52% and 86% / 69% / 82% respectively. For the diagnosis of fovea avulsion, sensitivity, specificity and accuracy of MRI and arthrography were 81% / 46% / 54% and 56% / 75% / 71% respectively.

Conclusion: For Palmer 1B peripheral tear, MRI indicated high specificity with low sensitivity, while AG demonstrated high sensitivity with low specificity. MRI cannot detect small 1B tear, while AG might misdiagnose the prestyloid recess as 1B tear. For fovea avulsion, MRI indicated high sensitivity with low specificity, while AG demonstrated high specificity with low sensitivity. Rich fat tissue in the origin of the radio-ulnar ligament origin might be misdiagnosed as a fovea avulsion on MRI, while scar tissue prevented the contrast agent into the fovea that leaded AG findings less sensitive. Even MRI is more popular, AG still has an important role to cover the weakness of MRI.

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