Wrist MRA versus conventional MRI in diagnosing different causes of chronic wrist pain.
Waleed Riad Saleh, Assistant professor, Assiut University, Assiut, Egypt
Introduction:
Wrist joint has a Complex anatomy, and because it consists of multiple small structures with multiple joints in between, It necessitates high contrast and high-resolution imaging. With proper technique, MRA can provide more information than either conventional arthrography or unenhanced MRI either alone or in combination.
Materials and Methods:
37 patients with unexplained chronic wrist pain and suspected intra-articular derangement. Conventional MRI and MRA of the wrist as a single shot examination was performed for all patients. Wrist Arthroscopy was performed for 25 patients with suspected TFCC or other ligamentous injuries clinically and radiologically. The reports of MRI and MRA were compared with the intra-operative arthroscopic assessment being the gold standard.
Results:
Two different senior radiology consultants commented on MRI and MRA blindly. Results were compared to that of wrist arthroscopy performed by senior hand surgeon. MRA has the upper hand in diagnosing TFCC tears. Also, MRA has the best sensitivity and specificity regarding central TFCC tears, while in peripheral tears MRA less specific but still much better than MRI.
Conclusion:
Despite being invasive procedure, MRA is superior to conventional MRI in detection of TFCC and ligamentous lesions. Also, MRA is more sensitive and specific in detection of central TFCC tears than peripheral ulnar tears.
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