Role Of Direct Magnetic Resonance Arthrography In Evaluation Of Wrist Joint Instability

Abstract

Background: Magnetic resonance imaging (MRI) is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons. Aim: To assess the role of direct MR arthrography imaging in the diagnosis of tear and cartilaginous abnormalities of the triangular fibrocartilage and intrinsic ligaments of the wrist joint. Methods: A prospective cohort study conducted on 50 patients with chronic refractory unexplained wrist pain. All patients underwent initially a conventional MRI exam followed by conventional arthrography then MR arthrography while 20 patients only with suspected TFCC or ligamentous injuries clinically and radiologically underwent to MR arthroscope. Results: We compared MRI, MRA and arthroscopic findings of 20 patients, there were high statistically significant differences between the groups in terms of distal avulsion and LT ligament tear. As regarding central and peripheral TFCC tears; sensitivity, specificity, PPV, and NPV of MRI and MRA respectively were 82.4%, 87.8%, 80.5%, and 84.2% and 63.2%, 66.7%, 71.1%, and 68.5%. Conclusion: MR arthrography should be a fundamental part of the imaging protocol when wrist ligament injuries are suspected, as it achieves the highest level of diagnostic confidence especially for inconclusive cases, and also accurately delineates the location and type of the tear in conclusive ones.