Lateral ulnar collateral ligament of the elbow: Optimization of evaluationwith two-dimensional MR imaging

PURPOSE: To compare, in a cadaveric model, magnetic resonance (MR) imaging techniques with differing contrast and spatial resolution properties in the evaluation of disruption of the lateral ulnar collateral ligament (LUCL) a t the elbow. MATERIALS AND METHODS: LUCL tears were surgically created in eight of 28 ca daveric elbow specimens. All specimens underwent 1.5-T MR imaging with the following pulse sequences: T1-weighted spin echo (SE), intermediate-weighte d fast SE, fat-suppressed T2-weighted fast SE, gradient-recalled echo (GRE) with high spatial resolution, intermediate-weighted fast SE with high spat ial resolution, and fat-suppressed T1-weighted SE with intraarticular admin istration of gadopentetate dimeglumine (MR arthrography). All images were o btained in the oblique coronal plane. Two radiologists independently graded the LUCL with separate and side-by-side assessment. RESULTS: Areas under the receiver operating characteristic curve were as fo llows for readers A and B, respectively: T1-weighted SE imaging, 0.64 and 0 .62; intermediate-weighted fast SE imaging, 0.87 and 0.67; T2-weighted fast SE imaging, 0.68 and 0.69; GRE imaging, 0.56 and 0.68; MR arthrography, 0. 84 and 0.85; and intermediate-weighted imaging with high spatial resolution , 0.92 and 0.88. Inter-observer reliability was poor with T1-weighted SE im aging (kappa = 0.13) and CRE imaging (kappa = 0.18), fair with T2-weighted fast SE imaging (kappa = 0.36), and moderate with MR arthrography (kappa = 0.46), intermediate-weighted fast SE imaging (kappa = 0.55), and intermedia te-weighted imaging with high spatial resolution (kappa =0.59). CONCLUSION: Intermediate-weighted imaging with high spatial resolution and MR arthrography showed the greatest overall ability to enable the diagnosis of LUCL tears.