Abstract
To investigate the usefulness of high-resolution 3T magnetic resonance imaging (MRI) for the evaluation of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities among three groups: patients presenting with wrist pain who were (a) younger than age 50 years or (b) age 50 or older (PT<50 and PT≥50, respectively), and (c) asymptomatic controls who were younger than age 50 years (AC). High-resolution 3T MRI was evaluated retrospectively in 96 patients, including 47 PT<50, 38 PT≥50, and 11 AC. Two board-certified radiologists reviewed the MRI images independently. MRI features of TFCC injury were analysed according to the Palmer classification, and cartilage degeneration around the TFCC was evaluated using the Outerbridge classification. Differences in MRI findings among these groups were detected using chi-square test. Cohen's kappa was calculated to assess interobserver and intra-observer reliability. The incidence of Palmer class 1A, 1C and 1D traumatic TFCC injury was significantly (p<0.05) higher in PT≥50 than in PT<50 (class 1A: 47.4% versus 27.7%, class 1C: 31.6% versus 12.8%, and class 1D: 21.1% versus 2.1%). Likewise, MRI findings of TFCC degeneration were observed more frequently in PT≥50 than in PT<50 (p<0.01). Outerbridge grade 2 or higher cartilage degeneration was significantly (p<0.01) more frequently seen in PT≥50 than in PT<50 (55.3% versus 17% in the lunate, 28.9% versus 4.3% in the triquetrum, 73.7% versus 12.8% in the ulna). High-resolution wrist MRI at 3T enables detailed evaluation of TFCC traumatic injury and degenerative changes using the Palmer and Outerbridge classifications, with good or excellent interobserver and intra-observer reliability.
Highlights
Ulnar-sided wrist pain is attributable to several disease entities, and accurate diagnosis is important.[1,2] The Palmer classification has been widely used for diagnosis of traumatic or degeneration abnormalities of the triangular fibrocartilage complex (TFCC), including evaluation of carpal bone cartilage[3]; it is often difficult and challenging to differentiate between traumatic injury and degenerative change at magnetic resonance imaging (MRI) because of complex ulnar-sided wrist anatomy and limited published knowledge or experience on MRI findings of degenerative changes.[4,5]Degeneration of the wrist articular cartilage is described according to the subtypes of Palmer class 2 injury
Based on prior cadaveric studies,[11,12] it was hypothesised that the incidence of abnormal imaging findings in the TFCC and the degree of wrist cartilage degeneration is different among three groups: patients presenting with wrist pain who were (a) younger than age 50 years or (b) age 50 or older (PT
The study encompassed a total of 96 subjects, including 47 patients with wrist pain who were younger than age 50 years (PT
Summary
Ulnar-sided wrist pain is attributable to several disease entities, and accurate diagnosis is important.[1,2] The Palmer classification has been widely used for diagnosis of traumatic or degeneration abnormalities of the triangular fibrocartilage complex (TFCC), including evaluation of carpal bone cartilage[3]; it is often difficult and challenging to differentiate between traumatic injury and degenerative change at magnetic resonance imaging (MRI) because of complex ulnar-sided wrist anatomy and limited published knowledge or experience on MRI findings of degenerative changes.[4,5]Degeneration of the wrist articular cartilage is described according to the subtypes of Palmer class 2 injury. Ulnar-sided wrist pain is attributable to several disease entities, and accurate diagnosis is important.[1,2] The Palmer classification has been widely used for diagnosis of traumatic or degeneration abnormalities of the triangular fibrocartilage complex (TFCC), including evaluation of carpal bone cartilage[3]; it is often difficult and challenging to differentiate between traumatic injury and degenerative change at magnetic resonance imaging (MRI) because of complex ulnar-sided wrist anatomy and limited published knowledge or experience on MRI findings of degenerative changes.[4,5]. Recent advances in 3 T high-resolution MRI have enabled precise evaluation of morphological changes in the ulnar-sided wrist, including in the articular cartilage.8e10 the primary objective of the present study was to evaluate imaging findings of traumatic injury and degenerative change using the Palmer classification at 3 T high-resolution MRI, with assessment of interand intra-rater reliability. Based on prior cadaveric studies,[11,12] it was hypothesised that the incidence of abnormal imaging findings in the TFCC and the degree of wrist cartilage degeneration is different among three groups: patients presenting with wrist pain who were (a) younger than age 50 years or (b) age 50 or older (PT
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