MERRITT ISLAND, Florida—Three Tesla magnetic resonance imaging (3-T MRI) of the wrist effectively detects wrist ligament tears and may help patients with wrist injuries avoid unnecessary surgery, according to a study in the January issue of the American Journal of Roentgenology.1

"3-T MRI of the wrist is highly sensitive for the detection of intrinsic ligament tears and triangular fibrocartilage complex (TFCC) tears.”—Thomas Magee, MD
”3-T MRI of the wrist is highly sensitive for the detection of intrinsic ligament tears and triangular fibrocartilage complex (TFCC) tears,” concluded Thomas Magee, MD, a radiologist at Neuroskeletal Imaging in Merritt Island, Florida.

The new study included 49 patients who had both 3-T MRI and arthroscopy. The researchers found:
  • 51 tears with “gold standard” arthroscopy including 22 TFCC tears, 18 scapholunate tears and 11 lunatotriquetral tears
  • 41 of 51 tears also found with 3-T MRI
  • 3-T MRI identified 19 of 22 TFCC tears,16 of 18 scapholunate tears, and 9 of 11 lunatriquetral tears

There were no false positive readings on MRI.

MRI: high sensitivity, 100% specificity

MR sensitivity was 86% for TFCC tears, 89% for scapholunate tears, and 82% for lunatriquetral tears. MR specificity for detection of tears was 100%, the study showed. MR arthrography sensitivity for detection of ligament and TFCC tears was 100%.

There were 3 patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients went on to undergo arthroscopy with no tears seen.

"MR arthrography is more sensitive for ligament evaluation, but can result in false positive findings because of microperforations,” Dr. Magee concludes.

Translating research into practice

“The resolution with 3-T MRI is good [and] we are able to see the small ligaments a lot better and determine whether or not they are torn,” Dr. Magee said. “3-T MRI is beneficial to both the patient and the physician. If there is a problem, it provides a road map for the physician to use during surgery and eliminates any type of surgery for those who have normal findings. We are able to see bone bruises, cysts and other things that may be pain generators instead of ligament tears.”

The bottom line? “If [wrist] surgery is being contemplated, I advise people to have an MR scan to determine the cause of pain before arthroscopy,” Dr. Magee said.

Reference

1. Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR;2009;192:80-88.