Abstract
The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations.
Highlights
Licensee MDPI, Basel, Switzerland.In recent years, magnetic resonance imaging (MRI) has gained importance as an imaging modality for specific diagnosis of soft-tissue trauma of the fingers
The consensus reading with direct pulley characterization revealed a total of 22 flexor pulley ruptures in 11 of the 30 fingers
A dislocation and intercalation of the pulley stump grade 2 (DISLOC.RUPT) between the flexor tendon and finger phalanx was observed in 62.5% of the pulley lesions
Summary
Licensee MDPI, Basel, Switzerland.In recent years, magnetic resonance imaging (MRI) has gained importance as an imaging modality for specific diagnosis of soft-tissue trauma of the fingers. Among the most common injuries in this new Olympic discipline, but they are observed in non-climbers when high-impact forces act on an inflected finger [2,4,5] Correct diagnosis of these injuries is necessary for therapy planning, as the pulley system is essential for unrestrained finger flexion. Diagnostic methods applying ultrasound (US) or MRI are usually based on indirect evaluation of pulley ruptures via measurement of an increased, pathologic distance between finger flexor tendons and adjacent bone, referred to as bowstringing [8]. This indirect approach may be insufficient to differentiate between isolated and combined pulley ruptures [9]. Improving imaging might result in better detection of potential injury complications affecting prognosis, such as intercalation of a dislocated ruptured pulley stump between the flexor tendon and the bony cortex [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
