Radiologist Identification of Occult Dorsal Wrist Ganglion Cysts on MRI

Abstract

Background Occult dorsal ganglion cysts (ODGC) require imaging or an operation for detection. It is currently unknown how often a radiologist identifies an ODGC on magnetic resonance imaging (MRI) and whether surgeon indication for MRI aids the radiologist in detection.

Questions/Purposes The aim of the study was to investigate the following questions: how accurately do radiologists identify ODGC on MRIs? What factors may be associated with missed ODGCs?

Patients and Methods We retrospectively studied patients who underwent an operation for an ODGC and had a preoperative wrist MRI. Radiology report and surgeon's notes were evaluated to determine whether identification of the ODGC was noted and whether the surgeon indicated that the MRI was to evaluate for an ODGC. MRIs were reviewed, dimensions of cysts measured and volume of cyst calculated.

Results Twenty-four patients and 25 MRIs were analyzed. The radiologist identified the ODGC in 19 cases (76%). Fifteen of the 25 MRIs (60%) ordered had ODGC listed in the requisition comment by the ordering surgeon. Thirteen of these 15 (87%) ODGCs were seen by the radiologist. Ten of the 25 MRIs (40%) ordered did not mention ODGC in the requisition. Six of these 10 (60%) ODGCs were seen by the radiologist. The volume of the ODGCs missed by radiologists was smaller (mean, 0.049 cm³) than those the radiologists identified (mean, 0.31 cm³; p = 0.004).

Conclusions Radiologists will not always identify the ODGC on an MRI, but they were more likely to if the surgeon was concerned for one. Hand surgeons should report suspicion of an ODGC on MRI requisition and review all imaging independently.

Level of Evidence This is a Level III, prognostic study.

Keywords

ganglion cyst - MRI - imaging - cyst - radiology

Ethical Approval

This study was approved by the Biomedical Institutional Review Board of The Ohio State University, 2017E0187.

• References

• 1 Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am 1976; 1 (03) 228-235
• 2 Couzens G, Daunt N, Crawford R, Ross M. Positive magnetic resonance imaging findings in the asymptomatic wrist. ANZ J Surg 2014; 84 (7,8): 528-532
• 3 Lowden CM, Attiah M, Garvin G, Macdermid JC, Osman S, Faber KJ. The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation. J Hand Surg [Br] 2005; 30 (03) 302-306
• 4 Andrén L, Eiken O. Arthrographic studies of wrist ganglions. J Bone Joint Surg Am 1971; 53 (02) 299-302
• 5 Westbrook AP, Stephen AB, Oni J, Davis TR. Ganglia: the patient's perception. J Hand Surg [Br] 2000; 25 (06) 566-567
• 6 Meena S, Gupta A. Dorsal wrist ganglion: current review of literature. J ClinOrthop Trauma 2014; 5 (02) 59-64
• 7 Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand SurgEur Vol 2007; 32 (05) 502-508
• 8 Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg Am 2015; 40 (03) 546-53.e8
• 9 Kang L, Akelman E, Weiss AP. Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am 2008; 33 (04) 471-475
• 10 Vo P, Wright T, Hayden F, Dell P, Chidgey L. Evaluating dorsal wrist pain: MRI diagnosis of occult dorsal wrist ganglion. J Hand Surg Am 1995; 20 (04) 667-670
• 11 Goldsmith S, Yang SS. Magnetic resonance imaging in the diagnosis of occult dorsal wrist ganglions. J Hand SurgEur Vol 2008; 33 (05) 595-599