Added Diagnostic Value of Radial Plane View for Evaluation of TFCC injury in CT Arthrography of the Wrist

Presentation Format: Scientific poster presentation.

Purpose or Learning Objective: To assess advantages in diagnostic accuracy and confidence provided by radial multiplanar reconstructions (MPRs) over standard planes for triangular fibrocartilage complex (TFCC) lesions in computed tomography (CT) arthrography.

Methods or Background: A total of 106 patients (49 women, 57 men; 44.2 ± 15.8 years of age) underwent CT imaging after multicompartment arthrography of the wrist. Two radiologists (R1, R2) analyzed three randomized data sets for each CT arthrography. One set contained only axial, coronal, and sagittal planes; the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid or in the ulnar fovea. Readers evaluated the visibility and condition of both TFCC layers. Lesions were categorized according to the classifications of Palmer and Atzei. Diagnostic confidence was stated on a 5-point Likert scale.

Results or Findings: Visualization of the superficial (MPRFovea: R1/R2, p < 0.001/<0.001; MPRStyloid: p = 0.007/<0.001) and deep (all p < 0.001) TFCC layer was superior with the addition of radial reconstructions. Palmer and Atzei lesions were present in 86.8% and 52.8% of patients, respectively. Specificity, sensitivity, and accuracy for central Palmer lesions did not differ for radial and standard MPRs. For peripheral Atzei lesions, sensitivity (Standard 0.79/0.80; Styloid 0.95/0.95; Fovea 0.91/0.89) and accuracy (Standard 0.87/0.86; Styloid 0.96/0.95; Fovea 0.94/0.92) improved with the addition of the styloid-centered (p = .004/.008) and fovea-centered (p = 0.039/0.125) reconstructions. No difference was observed between both radial MPRs (p = 0.688/0.250). Diagnostic confidence increased with the addition of either radial MPR (all p < 0.001). Interrater agreement was very good for each data set (Standard κ = 0.862; Styloid κ = 0.878; Fovea κ = 0.933).

Conclusion: Additional radial MPRs improve diagnostic accuracy and the confidence of readers to detect peripheral TFCC lesions in CT arthrography of the wrist.

Publication History

Article published online:
03 June 2021