ARRS 2022 Abstracts


E1429. Radial Reformatting of Isotropic 3D Sequences Improves Diagnostic Accuracy for Ulnar-Sided TFCC Lesions in MR Arthrography of the Wrist
  1. Jan-Peter Grunz; University Hospital Würzburg
  2. Andreas Kunz; University Hospital Würzburg
Triangular fibrocartilage complex (TFCC) injuries induce ulnar-sided wrist pain and can cause distal radioulnar joint instability. Due to its complex 3D composition, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The goal of this study was to assess the added diagnostic value of radial reformations of isotropic 3D MRI compared to standard planes after direct arthrography of the wrist.

Materials and Methods:
Ninety-three patients underwent fluoroscopy-guided, multi-compartment arthrography of the wrist with subsequent MRI. Two radiologists analyzed two datasets for each MR arthrogram, with one set containing standard reconstructions of a T2-weighted 3D thin-slice sequence in axial, coronal, and sagittal orientation, whereas the other set comprised an additional radial multiplanar reconstruction with the rotating center positioned at the ulnar styloid. Arthroscopy reports (available for 35 patients) or radiological reports by musculoskeletal imaging specialists combined with clinical follow-up served as standard of reference. Diagnostic confidence and assessability of the central disc and ulnar-sided TFCC insertions were subjectively evaluated.

Injuries of the articular disc, styloid, and foveal ulnar insertion were present in 20 (23.7%), 10 (10.8%), and 9 (9.7%) patients. Additional radial planes increased the 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 available.

Requiring little time and effort, the reconstruction of radial planes in post-processing of isotropic 3D MRI allows for superior diagnostic accuracy and confidence in the assessment of the peripheral TFCC attachments.