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.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 June 2021