Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population

Background The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods Thirty three patients with chronic wrist pain suspected to have ligament inj...

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Bibliographic Details
Published in:Indian journal of orthopaedics 2019-11, Vol.53 (6), p.769-775
Main Authors: Mehta, Nishank H., Garg, Bhavuk, Ansari, Tahir, Srivastava, Deep N., Kotwal, Prakash P.
Format: Article
Language:English
Subjects:
Arthritis
Arthroscopy
Comparative analysis
Conservative Orthopedics
Endoscopic surgery
Injuries
Iodine
Joints
Ligaments
Medicine & Public Health
NMR
Nuclear magnetic resonance
Original
Original Article
Orthopedics
Pain
Pathology
Patients
Studies
Surgeons
Surgical Orthopedics
Trauma
Wrist
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Summary:Background The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). Results For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. Conclusions The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.
ISSN:0019-5413
1998-3727
DOI:10.4103/ortho.IJOrtho_92_19