Indirect MR Arthrography of the wrist in the diagnosis of TFCC-lesions.

Purpose: The objective of this prospective study was to assess the value of the indirect MR arthrography (MR-AR) of the wrist in the detection of lesi ons of the TFCC. Material and methods: indirect MR-AR was performed in 45 p atients (23 f/22 m) with unclear ulnar wrist pain. After i.v. injection of 0.1 mmol/kg Gd-DTPA and after a motion-phase of the wrist (15 minutes) MRI was performed in a coronal plane. We used a STIR-, a fatsaturated (fs) T1-S E and a 3D-DESS sequence. The images were evaluated by two radiologists usi ng a consensus score. The lesions were assigned to the system of Palmer and correlated with arthroscopy. Results: Indirect MR-AR showed in 35 of 45 pa tients a lesion of the TFCC, but arthroscopy only revealed a defect in 32 c ases. This means three false positive but no false negative assessments by MRI. Using this MRI protocol sensitivity and specificity in the detection o f TFCC lesions were calculated as 100% and 77%. The accuracy was 93%. Small degenerative changes of the fibres were most common (Palmer type IIA). In trauma patients the ligaments usually showed tears near the insertion at th e ulna (Palmer type IB). The sensitivity and specificity was 88% and 95% fo r evaluation of the scapho-lunate (SL) ligament, the accuracy was 93%. Arth roscopy and MRI did not diagnose any rupture of the lunate-triquetral (LT) ligament. Conclusion: Indirect MR-AR is a non-invasive method with a high s ensitivity in the evaluation of the TFCC and associated injuries. Therefore , it is an excellent screening procedure to assess the indication for thera peutic arthroscopy.