Abstract
ObjectivesTriangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist.MethodsNinety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated.ResultsInjuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers’ confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting.ConclusionsAccess to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions.Key Points• In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex.• Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions.• Additional radial planes provide greater diagnostic confidence.
Highlights
With a two-layered, three-dimensional composition and multiple miniscule components contributing to its integrity, the triangular fibrocartilage complex (TFCC) is considered to be one of the most challenging regions from an imaging perspective
Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions
Assessability of the superficial (31.2% vs. 65.6%; p < 0.001) and deep (35.5% vs. 71.0%; p < 0.001) ulnar-sided layer of the TFCC was superior with addition of radial reformatting (Table 1)
Summary
With a two-layered, three-dimensional composition and multiple miniscule components contributing to its integrity, the triangular fibrocartilage complex (TFCC) is considered to be one of the most challenging regions from an imaging perspective. It consists of several conjoint parts with different vascularization patterns that influence the available treatment in case of discontinuity [1]. The deep layer of the ulnar-sided TFCC is formed by the triangular ligament that arises from the convergence of the palmar and dorsal radioulnar ligaments It functions as the main stabilizer of the distal radioulnar joint (DRUJ) during pronation and supination [4]. Fat tissue is usually discernible between the foveal and styloid lamina
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