J Korean Soc Radiol.  2011 Mar;64(3):265-271. 10.3348/jksr.2011.64.3.265.

The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

• Kim TY
• Lee GY
• Kim BH
• Park JW
• Seo BK
• Cha SH

• KMID: 2097949
• DOI: http://doi.org/10.3348/jksr.2011.64.3.265

Abstract

PURPOSE
To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings.
MATERIALS AND METHODS
A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5- or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values.
RESULTS
The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000).
CONCLUSION
Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.

MeSH Terms

Arthrography
Humans
Joints
Ligaments
Magnetic Resonance Imaging
Punctures
Sensitivity and Specificity
Triangular Fibrocartilage
Wrist
Wrist Joint

Figure

• 

  Fig. 1 A 33-year-old male with chronic wrist pain had no contrast leakage into the distal radioulnar joint at the beginning of dynamic cine arthrography (A). However, after passive wrist exercise, delayed contrast leakage was detected into the distal radioulnar joint, indicating perforation of the triangular fibrocartilage complex (B, arrow). Coronal MR arthrography also showed a Palmer type I triangular fibrocartilage complex tear (C, arrow), which was confirmed by arthroscopic operation.

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