HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haims, A. H. Articles by Culp, R. W. Search for Related Content PubMed PubMed Citation Articles by Haims, A. H. Articles by Culp, R. W.

Internal Derangement of the Wrist: Indirect MR Arthrography versus Unenhanced MR Imaging¹

¹ From the Department of Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042 (A.H.H., R.C.L.); and Departments of Radiology (M.E.S., W.B.M., D.D.) and Orthopedic Surgery (A.L.O., J.M.B., J.S.T., R.W.C.), Thomas Jefferson University Hospital, Philadelphia, Pa. From the 2000 RSNA scientific assembly. Received April 4, 2002; revision requested June 12; final revision received October 28; accepted October 31. Address correspondence to (e-mail: andrew.haims@yale.edu).

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
PURPOSE: To compare indirect magnetic resonance (MR) arthrography with unenhanced MR imaging of the wrist for evaluation of the central disk of the triangular fibrocartilage complex (TFCC) and the scapholunate and lunotriquetral interosseous ligaments.

MATERIALS AND METHODS: Eighty-six wrists were evaluated at MR imaging (41 indirect MR arthrography and 45 unenhanced MR imaging examinations). Three musculoskeletal radiologists independently evaluated the central disk of the TFCC and scapholunate and lunotriquetral ligaments and compared the results with those of wrist arthroscopy. Sensitivity and specificity were calculated for each of the readers, and the means were obtained. Sensitivities and specificities were compared with the Student t test.

RESULTS: Thirty-three tears of the central disk of the TFCC and 13 scapholunate and 18 lunotriquetral ligament tears were identified at arthroscopy. Sensitivities and specificities were 54%–73% and 83%–91%, respectively, in the evaluation of the central disk of the TFCC, with no significant difference between indirect MR arthrography (P = .666) and unenhanced MR imaging (P = .559). Sensitivities and specificities in the evaluation of the scapholunate ligament were 38%–69% and 75%–99%, respectively, with a significant improvement in sensitivity at indirect MR arthrography (P = .017) and no significant difference in specificity (P = .876). Sensitivities in the evaluation of the lunotriquetral ligament were poor, 0%–22%, though the specificities were 88%–99%, with no significant difference between indirect MR arthrography and unenhanced MR imaging (P = .592 and P = .354, respectively, for sensitivity and specificity.

CONCLUSION: Indirect MR arthrography significantly improves sensitivity in the evaluation of the scapholunate ligament when compared with unenhanced MR imaging of the wrist but does not significantly improve the ability to evaluate the central disk of the TFCC or the lunotriquetral ligament.

© RSNA, 2003

Index terms: Ligaments, injuries, 43.483 • Wrist, arthrography, 43.122 • Wrist, injuries, 43.483 • Wrist, MR, 43.121411, 43.121412, 43.121415, 43.12143

	INTRODUCTION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Magnetic resonance (MR) imaging has been shown to be an accurate modality for the evaluation of the central disk of the triangular fibrocartilage complex (TFCC) (1–9). The results of unenhanced imaging of the scapholunate ligament have been variable, with sensitivities from 52% to 86% and specificities from 34% to 100% (3,10). Evaluation of the abnormal lunotriquetral ligament with MR imaging has had more disappointing results, with sensitivities from 0% to 56% and specificities from 97% to 100% (3,11).

Indirect MR arthrography has shown promise in the evaluation of intraarticular structures, providing internal contrast without the invasiveness of a direct intraarticular puncture. It has been shown to increase the number of perceived articular cartilage defects in the knee (12). To our knowledge, there has been no large-scale comparison between unenhanced MR imaging and indirect MR arthrography. The purpose of our study was to compare indirect MR arthrography with unenhanced MR imaging of the wrist for theevaluation of the central disk of the TFCC and the scapholunate and lunotriquetral interosseous ligaments.

	MATERIALS AND METHODS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Patients
Institutional board review approval was obtained prior to our study. Informed consent was not required by the institutional review board. We evaluated findings of 86 consecutive wrist MR examinations during 6 years in 85 patients who were referred by a large academic practice of hand surgeons and who underwent MR imaging of the wrist and subsequent arthroscopy. There were 47 male and 38 female patients (mean age, 37.5 years; age range, 7–62 years). Forty-one were indirect MR arthrograms, and 45 were unenhanced MR images. The mean age of the patients (21 male, 20 female) who underwent indirect MR arthrography was 37.0 years (age range, 7–57 years), and the mean age of the patients (26 male, 19 female) who underwent unenhanced MR imaging was 38.5 years (age range, 12–62 years).

MR Imaging
All MR examinations were performed with 1.5-T superconducting magnets (Signa Advantage 5x; GE Medical Systems, Milwaukee, Wis). Patients were imaged with either a dedicated wrist coil (Quadrature; IGC-Medical Advances, Milwaukee, Wis) or two 3-inch (7.6-cm) round general purpose coils (GE Medical Systems). The selection of patients was based solely on the availability of a radiologist to administer the intravenous injection.

For indirect MR arthrography, a standard dose of 0.1 mmol per kilogram of body weight of gadopentetate dimeglumine (Magnevist; Berlex, Richmond, Calif) was intravenously administered. Injection was performed prior to imaging, and no precontrast images were obtained. Although there was no formal delay after injection, routine injection was performed prior to positioning of the patient in the MR imager, and the time before imaging was initiated was approximately 5–10 minutes. The parameters for indirect MR arthrography consisted of coronal fast spin-echo fat-suppressed T2-weighted sequences (6,000/70 [repetition time msec/echo time msec], 256 x 256 matrix, four signals acquired, echo train length of four, 10-cm field of view, 3-mm section thickness, 1-mm intersection gap); coronal three-dimensional gradient-echosequences (46/15, 45° flip angle, 256 x 128 matrix, two signals acquired, 8-cm field of view, 1.2-mm section thickness, 0-mm intersection gap); coronal T1-weighted spin-echo sequences (500/14, 256 x 192 matrix, three signals acquired, field of view of 10, 3-mm section thickness, 1-mm intersection gap); and coronal and transverse fat-suppressed two-dimensional spoiled gradient-echo sequences (220/9.3, 90° flip angle, 256 x 128 matrix, two signals acquired, 10-cm field of view, 3-mm section thickness, 1-mm intersection gap).

The parameters for unenhanced MR imaging consisted of coronal fast spin-echo fat-suppressed T2-weighted sequences (6,000/ 70, 256 x 256 matrix, four signals acquired, echo train length of four, 10-cm field of view, 3-mm section thickness, 1-mm intersection gap); coronal three-dimensional gradient-echo sequences (58/12, 10° flip angle, 256 x 128 matrix, two signals acquired, 8-cm field of view, 1.2-mm section thickness, 0-mm intersection gap); coronal T1-weighted spin-echo sequences (500/14, 256 x 192 matrix, three signals acquired, 10-cm field of view, 3-mm section thickness, 1-mm intersection gap); and transverse fast spin-echo fat-suppressed T2-weighted sequences (8,000/85, 256 x 256 matrix, four signals acquired, echo train length of eight, 10-cm field of view, 3-mm section thickness, 1-mm intersection gap).

Image Evaluation and Arthroscopy
Three experienced musculoskeletal radiologists (M.E.S., W.B.M,.D.D.) separately evaluated the central disk of the TFCC and the scapholunate and lunotriquetral ligaments. The normal central disk of the TFCC is primarily of low signal intensity (Fig 1). The scapholunate and lunotriquetral ligaments also appear as primarily low-signal-intensity structures without intervening fluid signal intensity (Figs 2, 3). Each structure was classified as not completely torn or as completely torn. For a complete tear, the readers had to see disruption of the fibers or fluid signal intensity between the fibers of the central disk of the TFCC (Fig 4), the scapholunate (Fig 5) ligament, and the lunotriquetral ligament (Fig 6). Partial tears were not specifically evaluated and were classified as not completely torn. The readers were unaware of the surgical findings.

View larger version (151K): [in this window] [in a new window] [Download PPT slide]   Figure 1a. Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 1b. Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 2a. Images in two different patients with normal scapholunate ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the scapholunate ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows).

View larger version (148K): [in this window] [in a new window] [Download PPT slide]   Figure 2b. Images in two different patients with normal scapholunate ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the scapholunate ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows).

View larger version (130K): [in this window] [in a new window] [Download PPT slide]   Figure 3a. Images in two different patients with normal lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 41-year-old man illustrates a normal low-signal-intensity appearance of the lunotriquetral ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low signal intensity of the lunotriquetral ligament (arrows).

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 3b. Images in two different patients with normal lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 41-year-old man illustrates a normal low-signal-intensity appearance of the lunotriquetral ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low signal intensity of the lunotriquetral ligament (arrows).

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 4a. Images in two different patients with tears of the central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the ulnar side of the lunate, which is consistent with ulnar impaction syndrome. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows).

View larger version (137K): [in this window] [in a new window] [Download PPT slide]   Figure 4b. Images in two different patients with tears of the central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the ulnar side of the lunate, which is consistent with ulnar impaction syndrome. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows).

View larger version (135K): [in this window] [in a new window] [Download PPT slide]   Figure 5a. Images in two different patients with torn scapholunate ligaments. (a) Coronal T1-weighted fat-suppressed indirect MR arthrogram (500/14) in a 53-year-old woman demonstrates fluid signal intensity (arrows) between the scaphoid and the lunate. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the scapholunate ligament (arrows).

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 5b. Images in two different patients with torn scapholunate ligaments. (a) Coronal T1-weighted fat-suppressed indirect MR arthrogram (500/14) in a 53-year-old woman demonstrates fluid signal intensity (arrows) between the scaphoid and the lunate. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the scapholunate ligament (arrows).

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 6a. Images in two different patients with torn lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 33-year-old man illustrates abnormal high signal intensity (arrows) through the region of the lunotriquetral ligament. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity in the region of the lunotriquetral ligament (arrows).

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 6b. Images in two different patients with torn lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 33-year-old man illustrates abnormal high signal intensity (arrows) through the region of the lunotriquetral ligament. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity in the region of the lunotriquetral ligament (arrows).

Statistical Evaluation
Patient ages and the date of indirect MR arthrography and unenhanced MR imaging were compared by using an unpaired t test. Sensitivity and specificity were calculated for each of the three readers. The average sensitivity and specificity were determined for the three readers. Statistical comparisons of the mean sensitivity and specificity were performed by using the Student t test, with P < .05 considered to indicate a statistically significant difference. values were obtained to determine the agreement between the three readers.

	RESULTS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Arthroscopic evaluation of the central disk of the TFCC yielded 33 complete tears, with 16 cases observed at indirect MR arthrography and 17 cases observed at unenhanced MR imaging. There were 13 complete scapholunate tears: four observed at indirect MR arthrography and nine were observed at unenhanced MR imaging. Eighteen complete tears of the lunotriquetral ligament were documented, nine each at indirect MR arthrography and unenhanced MR imaging.

There was no significant difference (P = .561) between the ages of patients who underwent indirect MR arthrography and those who underwent unenhanced MR imaging, with mean ages of 37.0 and 38.5 years, respectively. The mean time of indirect MR arthrography was 6 months and 12 days after that of the unenhanced MR imaging. This was not statistically significant (P = .109)

The average sensitivity of the three readers in the evaluation of the central disk of the TFCC was 63%, with no significant difference (P = .666) between indirect MR arthrography (65%) and unenhanced MR imaging (61%) (Table 1). The average specificity was 88% (87% for indirect MR arthrography and 89% for unenhanced MR imaging), with no significant difference between the two groups (P = .559). The value for reader 1 versus reader 2 was 0.711 (substantial agreement); that for reader 1 versus reader 3, 0.583 (moderate agreement); and that for reader 2 versus reader 3, 0.691 (substantial agreement).

	DISCUSSION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

Indirect MR arthrography, particularly with regard to its application in the wrist, is a relatively new technique with limited evaluation in the literature. Indirect MR arthrography is predicated on the fact that intravenously injected contrast material diffuses into the joint in such concentrations that an arthrographic effect can be obtained on T1-weighted images without decrease in the signal-to-noise ratio of long repetition time sequences. Theoretically, this technique is well suited for the wrist, where little joint distention is needed and there is a relatively short distance for contrast material to diffuse (13). If successful, this procedure could circumvent the risks, time, and discomfort of direct intraarticular injection.

Our results of the evaluation of the central disk of the TFCC clearly demonstrate that indirect MR arthrography does not improve detection of tears in comparison with unenhanced MR imaging. Our data are surprising in demonstrating a poor sensitivity in comparison with the findings in previous reports in which MR imaging of the TFCC was evaluated. Reported sensitivities ranged from 52% to 100%, with the majority close to 90% (1–8). The reasons for this, we believe, are multifactorial. First, we included all patients in our study, provided that they had preoperative MR imaging findings available for interpretation and an arthroscopic report. Some of the MR examination findings we reviewed were of poor quality. Interpretation of findings of MR examinations of the wrist, as opposed to those of larger joints, is technically dependent on image quality. Image quality frequently is inferior with patient motion, poor fat suppression, and metallic artifact from orthopedic hardware. By today’s best practices, we believe that images in approximately a third of our cases would no longer be considered of optimal image quality.

There have been two studies in which the normal appearance of the scapholunate ligament at gradient-echo sequences was systematically evaluated (14,15). Authors of both studies consistently identified the normal components of this ligament. However, in the evaluation of the abnormal scapholunate ligament, results in published studies have not been as consistent. Zlatkin et al (3) reported sensitivities and specificities of 86% and 100%, respectively, in 20 cases (seven tears). Potter et al (8) had similar results in the evaluation of 53 patients with 17 ligament tears (sensitivity of 88% and specificity of 100%). Scheck et al (10) had much lower sensitivities and specificities (52% and 34%, respectively) in 41 patients with 17 ligament tears. Schweitzer et al (2) had similar results in 15 patients (five tears) using nonvisualization of the ligament or abnormal morphology as a sign of tear, with sensitivities of 25% and 20%, respectively, and specificities of 86% and 78%, respectively. Totterman et al (16) evaluated 15 cadavers and eight patients for scapholunate abnormalities. They had three true-positive and three false-negative findings in their cadaveric study, and no ligament tears at imaging or surgery in their clinical patients.

In comparison with previous study results, our results for the scapholunate ligament are in the lower range of sensitivities (average, 56%; indirect MR arthrography, 92%; unenhanced MR imaging, 41%) but in the upper range of specificities (average, 89%; indirect MR arthrography, 88%; unenhanced MR imaging, 90%). None of the previously mentioned studies had the number of patients as were in our study group (n = 86) but they had similar numbers of ligament tears (n = 13). We have also demonstrated a significant difference between indirect MR arthrography and unenhanced MR imaging in the detection of a scapholunate ligament tear.

The lunotriquetral ligament has been more difficult to evaluate from an imaging standpoint. Smith and Snearly (17) showed that the lunotriquetral ligament could be consistently identified in 75 normal volunteers. They described the normal morphology and signal intensity of the ligament. However, evaluation of the abnormal lunotriquetral ligament has been more disappointing. Zlatkin et al (3) demonstrated a sensitivity of 50% and a specificity of 100% in 20 patients (eight ligament tears). Potter et al (8) demonstrated a sensitivity of 40% and a specificity of 97% in 53 cases (five ligament tears). Totterman et al (16) described five true-positive, one false-negative, and two false-positive findings in 15 cadavers. In their clinical study of eight patients, there were two true-positive and six true-negative findings. Schweitzer et al (2) evaluated 15 patients with four ligament tears. They demonstrated a sensitivity of 69% and a specificity of 56% using nonvisualization as a sign of ligament tear. By using alterations in the ligament morphology as a sign of tear, the sensitivity and specificity were 31% and 90%, respectively. Johnstone et al (11) published a sensitivity of 0% and a specificity of 97% in the evaluation of the lunotriquetral ligament.

Our data show sensitivities in the lower range of those in published studies, with specificities in the upper range (average sensitivity of 7% for both groups, 11% for indirect MR arthrography, and 4% for unenhanced MR imaging; average specificity of 93% for both groups, 96% for indirect MR arthrography, and 92% for unenhanced MR imaging). Again, none of the previous studies have had our number of patients (n = 86) but have had similar numbers of ligament tears (n = 18). There was no significant difference in the detection of lunotriquetral ligament tears between indirect MR arthrography and unenhanced MR imaging.

There were several limitations in this study. First, an indeterminate number of patients were excluded because of the inability to locate either their imaging study findings or their surgical reports, potentially leading to a population bias. Additionally, secondary to the retrospective nature of this study, it was impossible to determine how many patients were imaged with the dedicated wrist coil versus with two 3-inch (7.6-cm) surface coils. Also, patients were not exercised after injection, which may have aided in an increased arthrographic effect. The time between MR imaging and arthroscopic surgery was not immediate (mean, 2.5 months; range, 1 week to 10 months). This may have been a potential cause of error as patients could theoretically have injuries that occurred during the interval; however, we consider this to be minimal. And lastly, the image quality for many of the patients would no longer be considered optimal.

Despite the limitations of this study, our results have shown a significant improvement in the evaluation of the scapholunate ligament with indirect MR arthrography and no significant improvement in the evaluation of the central disk of the TFCC or the lunotriquetral ligament. Although indirect arthrography significantly improves the sensitivity of detection of scapholunate tears, we do not believe that indirect arthrography is indicated for routine use in the evaluation of internal derangement of the wrist, but it may be useful in the evaluation for scapholunate disease.

	FOOTNOTES

 
Abbreviation: TFCC = triangular fibrocartilage complex

Author contributions: Guarantor of integrity of entire study, A.H.H.; study concepts and design, A.H.H., M.E.S., W.B.M.; literature research, A.H.H.; clinical studies, A.L.O., J.M.B., J.S.T., R.W.C.; data acquisition, A.L.O., J.M.B., J.S.T., R.W.C., M.E.S., D.D., W.B.M.; data analysis/interpretation, A.H.H., R.C.L.; statistical analysis, A.H.H., R.C.L.; manuscript editing and revision/review, A.H.H., M.E.S., W.B.M.; manuscript preparation, definition of intellectual content, and final version approval, A.H.H.

	REFERENCES

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 

1. Golimbu CN, Firooznia H, Melone CP, Jr, Rafii M, Weinreb J, Leber C. Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology 1989; 173:731-733.[Abstract/Free Full Text]
2. Schweitzer ME, Brahme SK, Hodler J, et al. Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional MR arthrography. Radiology 1992; 182:205-211.[Abstract/Free Full Text]
3. Zlatkin MB, Chao PC, Osterman AL, Schnall MD, Dalinka MK, Kressel HY. Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 1989; 173:723-729.[Abstract/Free Full Text]
4. Pederzini L, Luchetti R, Soragni O, et al. Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography and magnetic resonance imaging. Arthroscopy 1992; 8:191-197.[Medline]
5. Cerofolini E, Luchetti R, Pederzini L, et al. MR evaluation of the triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy. J Comput Assist Tomogr 1990; 14:963-967.[Medline]
6. Totterman SM, Miller RJ, McCance SE, Meyers SP. Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence. Radiology 1996; 199:227-232.[Abstract/Free Full Text]
7. Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol 1997; 168:1513-1518.[Abstract/Free Full Text]
8. Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am 1997; 79:1675-1684.[Abstract/Free Full Text]
9. Nakamura T, Yabe Y, Horiuchi Y. Fat suppression magnetic resonance imaging of the triangular fibrocartilage complex: comparison with spin echo, gradient echo pulse sequences and histology. J Hand Surg [Br] 1999; 24:22-26.[CrossRef][Medline]
10. Scheck RJ, Kubitzek C, Hierner R, et al. The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy. Skeletal Radiol 1997; 26:263-271.[CrossRef][Medline]
11. Johnstone DJ, Thorogood S, Smith WH, Scott TD. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br] 1997; 26:714-718.
12. Winalski CS, Aliabadi P, Wright RJ, Shortkroff S, Sledge CB, Weissman BN. Enhancement of joint fluid with intravenously administered gadopentetate dimeglumine: technique, rationale, and implications. Radiology 1993; 187:179-185.[Abstract/Free Full Text]
13. Schweitzer ME, Natale P, Winalski CS, Culp RW. Indirect wrist MR arthrography: the effects of passive motion versus active exercise. Skeletal Radiol 2000; 29:10-14.[CrossRef][Medline]
14. Totterman SM, Miller RJ. Scapholunate ligament: normal MR appearance on three-dimensional gradient-recalled-echo images. Radiology 1996; 200:237-241.[Abstract/Free Full Text]
15. Smith DK. Scapholunate interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology 1994; 192:217-221.[Abstract/Free Full Text]
16. Totterman SM, Miller R, Wasserman B, Blebea JS, Rubens DJ. Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 160:117-123.[Abstract/Free Full Text]
17. Smith DK, Snearly WN. Lunotriquetral interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology 1994; 191:199-202.[Abstract/Free Full Text]

This article has been cited by other articles:

				T. Magee Comparison of 3-T MRI and Arthroscopy of Intrinsic Wrist Ligament and TFCC Tears Am. J. Roentgenol., January 1, 2009; 192(1): 80 - 85. [Abstract] [Full Text] [PDF]

				M. R. Schmid, T. Schertler, C. W. Pfirrmann, N. Saupe, M. Manestar, S. Wildermuth, and D. Weishaupt Interosseous Ligament Tears of the Wrist: Comparison of Multi-Detector Row CT Arthrography and MR Imaging Radiology, December 1, 2005; 237(3): 1008 - 1013. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haims, A. H. Articles by Culp, R. W. Search for Related Content PubMed PubMed Citation Articles by Haims, A. H. Articles by Culp, R. W.