Diagnostic Accuracy of Magnetic Resonance Imaging and Magnetic Resonance Arthrography for Triangular Fibrocartilaginous Complex Injury: A Systematic Review and Meta-Analysis

• Published in: Journal of bone and joint surgery. American volume 2012-05, Vol.94 (9), p.824-832
• Main Authors: Smith, Toby O, Drew, Benjamin, Toms, Andoni P, Jerosch-Herold, Christina, Chojnowski, Adrian J
• Format: Article
• Language: English
• Subjects: Adult; Arthrography; Biological and medical sciences; Diseases of the osteoarticular system; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Medical sciences; Orthopedic surgery; Osteoarticular system. Muscles; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Triangular Fibrocartilage - injuries; Wrist Injuries - diagnosis
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.J.01775

BACKGROUND:Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulnar-sided wrist pain and resultant functional disability. Diagnosis is based on the history and clinical examination as well as radiographic evidence of a TFCC central perforation or a radial/ulnar tear. The purpose of this study was therefore to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the detection of TFCC injury in the adult population. METHODS:Published and unpublished literature databases were searched. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary receiver operating characteristic curve evaluations were performed. The methodological quality of each study was assessed with use of the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. RESULTS:Twenty-one studies were included in the review, and these series included a total of 982 wrists. On meta-analysis, MRA was superior to MRI in the investigation of full-thickness TFCC tears, with a pooled sensitivity of 0.75 and a pooled specificity of 0.81 for MRI compared with 0.84 and 0.95, respectively, for MRA. MRA and MRI performed at greater field strengths were reported to have greater sensitivity and specificity than those performed at lower field strengths. There were insufficient data to assess the diagnostic test accuracy for partial-thickness TFCC tears. CONCLUSIONS:Given its acceptable diagnostic test accuracy, it is recommended that MRA, rather than MRI, be performed in when there are questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain. LEVEL OF EVIDENCE:Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.