THE UTILITY OF HIGH-RESOLUTION MAGNETIC-RESONANCE-IMAGING IN THE EVALUATION OF THE TRIANGULAR FIBROCARTILAGE COMPLEX OF THE WRIST

We performed a prospective study in order to assess the utility of hig h-resolution magnetic resonance imaging in the detection and specific localization of tears of the triangular fibrocartilage complex. Sevent y-seven patients who had pain in the wrist were studied with use of a dedicated surface coil and three-dimensional gradient-recalled techniq ues with a field of view of eight centimeters and a slice thickness of one millimeter. The patients had pain on the ulnar side of the wrist, ligamentous instability, occult ganglia, or a combination of these. M agnetic resonance images were assessed for radial or ulnar avulsion, o r both; central defects; degenerative intrasubstance changes; and comp lex tears of the triangular fibrocartilage complex. Partial tears were differentiated from complete tears. The findings on the magnetic reso nance images were then compared with the arthroscopic findings. Fifty- seven of the fifty-nine tears that were suspected on magnetic resonanc e images were confirmed with arthroscopy; the two suspected tears that were not confirmed had been interpreted as small partial tears on the magnetic resonance images. With use of arthroscopy as the standard, m agnetic resonance imaging had a sensitivity of 100 per cent (fifty-sev en of fifty-seven), a specificity of 90 per cent (eighteen of twenty), and an accuracy of 97 per cent (seventy-five of seventy-seven) for th e detection of a tear (kappa = 0.93, p < 0.00001). Fifty-three of the fifty-seven tears were localized correctly with use of magnetic resona nce imaging. With regard to the location of the tear, magnetic resonan ce imaging had a sensitivity of 100 per cent (fifty-three of fifty-thr ee), la specificity of 75 per cent (eighteen of twenty-four), and an a ccuracy of 92 per cent (seventy-one of seventy-seven) (kappa = 0.9, p < 0.0001). We concluded that high-resolution magnetic resonance imagin g permits accurate depiction and localization of tears of the triangul ar fibrocartilage complex. When the appropriate pulse sequence is used , magnetic resonance imaging is an accurate and effective method for t he non-invasive evaluation of pain in the wrist.