Gadolinium-enhanced MRI of the Wrist for Injuries of the Triangular Fibrocartilage Complex

Presentation Format: Scientific poster presentation.

Purpose or Learning Objective: With its complex three-dimensional structure, the diagnosis of triangular fibrocartilage complex (TFCC) lesions remains a challenging task for radiologists. Originating from the sigmoid notch of the radius is the avascular central disk, whereas the peripheral TFCC is vascularized and consists of a deep and superficial lamina that inserts in the ulnar fovea and at the ulnar styloid process, respectively. The aim of this study was to evaluate whether contrast-enhanced sequences provide added diagnostic value over plain magnetic resonance imaging (MRI) for the detection of TFCC injuries.

Methods or Background: A total of 232 patients with ulnar-sided wrist pain were scanned with 3-T MRI. Scan protocol included coronal and axial acquisition of T2-weighted turbo spin echo (TSE), as well as coronal acquisition of T1-weighted TSE before and after intravenous application of gadolinium. Two radiologists analyzed two randomized data sets for each examination in blinded fashion. One set comprised only unenhanced MR sequences; the other contained additional contrast-enhanced T1-weighted TSE. Observers assessed the condition of the articular disk and ulnar-sided TFCC periphery, and they stated their diagnostic confidence on a 5-point scale. Surgical and radiologic reports, as well as clinical follow-up, were used as the standard of reference. Based on signal intensity measurements in regions of interest, contrast-to-noise ratios (CNRs) were calculated in each patient with any form of TFCC discontinuity.

Results or Findings: Lesions of the articular disk and peripheral TFCC were present in 36 and 41 patients, respectively. Diagnostic sensitivity for central disk lesions was highly independent of access to contrast-enhanced sequences (plain MRI: 0.91/0.92; ceMRI: 0.90/0.92). Accordingly, CNR (plain T1: 8.42; T2: 19.81; ceT1: 12.12; p < 0.001) was highest in T2-weighted sequences. For peripheral TFCC injuries, sensitivity (plain MRI: 0.66/0.70; ceMRI: 0.94/0.93) improved considerably with the addition of contrast-enhanced T1 TSE (p < 0.001). CNR was also superior after gadolinium application (plain T1: 7.35; T2: 10.61; ceT1: 29.39; p < 0.001). In addition, diagnostic confidence for ulnar-sided lesions increased when observers had access to contrast-enhanced T1 TSE (p < 0.001). Interrater agreement was substantial in this study irrespective of data set (plain MRI: κ = 0.609, ceMRI: κ = 0.644).

Conclusion: Intravenous application of gadolinium improves diagnostic sensitivity, CNR, and readers’ confidence for peripheral lesions of the TFCC.

Publication History

Article published online:
03 June 2021