3T MRI of wrist ligaments and TFCC using true plane oblique 3d T2 Dual Echo Steady State (DESS) – a study of diagnostic accuracy
Objectives: This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3d T2DESS, in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold standard. Methods: In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3d T2 DESS sequence for assessing intrinsic ligaments and TFCC. At arthroscopy tears were classified using Geissler’s classification and compared to MRI findings. Results: The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87% and specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. Triangular fibrocartilage (TFCC) tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. Conclusion: 3T wrist MRI with dedicated reformats from 3d T2 DESS have a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3d T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. Advances in knowledge: This study assesses the diagnostic performance of unenhanced 3T MRI with 3dT2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported.