Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury.

PURPOSE: To determine whether high-resolution magnetic resonance imaging (MRI) could detect injuries to the triangular fibrocartilage complex (TFCC).

METHODS: Eleven patients who showed both a positive sign during the ulnocarpal stress test and tenderness at the distal end of the ulna had a high-resolution MRI using a 47-mm diameter microscopy coil. Six regions of the TFCC were investigated for injury: the radial attachment, disc, ulnar attachment of the triangular fibrocartilage (TFC), ulnotriquetral ligament, palmar radioulnar ligament (PRUL), and dorsal radioulnar ligament (DRUL). Arthroscopy was performed subsequently on each patient.

RESULTS: For injuries to the radial attachment or the disc of the TFC, a high-resolution MRI showed 100% sensitivity and 100% specificity compared with arthroscopy. In 3 cases in which injury to the ulnar attachment of the TFC was detected with MRI and examination showed a positive piano-key sign and distal radioulnar joint instability, only 1 injury was confirmed with arthrotomy. For MRI diagnosis of an ulnotriquetral ulnolunate attachment injury, the sensitivity was 100% and the specificity was 70%; however, 3 cases had false-positive results. Finally MRI had 100% sensitivity for detecting DRUL and PRUL injuries, although specificities were 75% and 83%, respectively. With MRI there were 2 false-positive DRUL injury diagnoses and 1 false-positive PRUL injury diagnosis.

CONCLUSIONS: High-resolution MRI using a microscopy surface coil allowed assessment of each TFCC component and showed a higher accuracy for diagnosing injuries to the radial attachment and the disc of the TFC compared with previous studies. High-resolution MRI, however, was not able to diagnose DRUL, PRUL, or ulnolunate ligament injuries accurately.

TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.