The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea Received November 6, 2010 ; Accepted January 8, 2011 Address reprint requests to : Guen Young Lee, M.D., Department of Radiology, Korea University Ansan Hospital, 516, Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Korea. Tel. 82-31-412-5227 Fax. 82-31-412-5224 E-mail: netty0523@hanmail.net Purpose: To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings. Materials and Methods: A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values. Results: The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000). Conclusion: Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.