Diagnostic accuracy of wrist MR-arthrography protocol using iodinated contrast agent only in the detection of intrinsic wrist ligament and triangular fibrocartilage complex tears.

Objectives: To determine the diagnostic accuracy of a wrist MR-arthrography (MR-A) protocol using iodinated contrast agent only compared to wrist diagnostic arthroscopy in the detection of tears of intrinsic ligaments and triangular fibrocartilage complex (TFCC).

Materials And Methods: This study retrospectively enrolled 39 patients who underwent MR-A using iodinated contrast agent only before arthroscopic examination between May 2019 and December 2021. For each patient, a resident (R1) and an experienced musculoskeletal radiologist (R2) independently reviewed the MR-A dataset. The performance in detecting and characterizing tears of intrinsic ligaments and TFCC was calculated against arthroscopic reports. Intra- and interrater agreements for MR-A were calculated too.

Results: Prevalence of ligament tear was 74% for scapholunate (SL) ligament, 51% for lunotriquetral (LT) ligament and 64% for TFCC. Wrist arthroscopy revealed cartilage lesions in 25.6%. Concerning SL tears, sensitivity, specificity, and accuracy of MR-A were 1.00, 0.70, and 0.92 (R1) and 0.90, 0.90, and 0.90 (R2). For LT tears, sensitivity, specificity, and accuracy were 0.90, 0.74, and 0.82 (R1) and 0.90, 0.84, and 0.87 (R2). Regarding TFCC tears, sensitivity, specificity, and accuracy were 0.80, 0.79, and 0.79 (R1) and 0.96, 0.86, and 0.92 (R2). Concerning SL tear characterization (partial versus complete tear), agreement between MR-A and arthroscopy was good (0.62 [0.42-0.83] for R1; 0.76 [0.60-0.91] for R2). Interobserver and intraobserver agreements for MR-A assessment were respectively good (0.68 [0.56-0.79]) and very good (0.92 [0.86-0.98]).

Conclusions: MR-arthrography with iodinated contrast agent only displays high sensitivity and specificity for ligamentous injuries, making this technique an interesting option for exploring wrist pain.