Wrist| Volume 32, ISSUE 6, P834-841, July 2007

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A Comparison of CT Arthrography of the Wrist to Findings During Wrist Arthroscopy


      To determine the accuracy of computed tomography after wrist arthrogram (CT arthrogram) compared with findings during wrist arthroscopy as interpreted by a musculoskeletal radiologist and a board-certified hand surgeon.


      Seventy-six consecutive patients who had a wrist CT arthrogram and subsequent wrist arthroscopy were identified in the arthroscopic database of four hand surgeons working at a single institution between 2001 and 2006. Operative findings were obtained from the medical record. A single, blinded, musculoskeletal fellowship-trained radiologist prospectively read all CT arthrograms focusing on the following areas: scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL), peripheral and central triangular fibrocartilage complex (TFCC), and chondral surfaces. Computed tomography arthrograms were also read in a blinded, prospective fashion by a single hand surgeon. The results of both readings were compared with the findings at the time of wrist arthroscopy.


      Sixteen SLIL tears, 29 LTIL tears, 10 peripheral TFCC tears, and 33 central TFCC tears were identified at the time of wrist arthroscopy. Sensitivity and specificity of the CT arthrogram were calculated using arthroscopy findings as our reference standard. The radiologist’s readings (sensitivity, specificity) revealed the following: SLIL (94%, 86%), LTIL (85%, 79%), peripheral TFCC (30%, 94%), and central TFCC (88%, 95%). Results of CT arthrogram readings by the hand surgeon were SLIL (94%, 82%), LTIL (97%, 81%), peripheral TFCC (40%, 97%), and central TFCC (91%, 85%).


      Computed tomography arthrogram of the wrist is highly accurate at detecting SLIL, LTIL, and central TFCC tears with high sensitivity and specificity. It is not as accurate at identifying peripheral tears.

      Type of study/level of evidence

      Diagnostic III.

      Key words

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        • Palmer A.K.
        • Levinsohn E.M.
        • Kuzma G.R.
        Arthrography of the wrist.
        J Hand Surg. 1983; 8: 15-23
        • Mikic A.D.
        Arthrography of the wrist joint: an experimental study.
        J Bone Joint Surg. 1984; 66A: 371-378
        • Zingberg E.M.
        • Palmer A.K.
        • Coren A.B.
        • Levinsohn E.M.
        The triple-injection wrist arthrogram.
        J Hand Surg. 1988; 13A: 803-810
        • Levinsohn E.M.
        • Rosen I.D.
        • Palmer A.K.
        Wrist arthrography: value of the three-compartment injection method.
        Radiology. 1991; 179: 231-239
        • Herbert T.J.
        • Faithfull R.G.
        • McCann D.J.
        • Ireland J.
        Bilateral arthrography of the wrist.
        J Hand Surg. 1990; 15B: 233-235
        • Wilson A.J.
        • Gilula L.A.
        • Mann F.A.
        Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases.
        AJR. 1991; 157: 105-109
        • Metz V.M.
        • Mann F.A.
        • Gilula L.A.
        Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography.
        AJR. 1993; : 1239-1243
        • Kirschenbaum D.
        • Sieler S.
        • Solonick D.
        • Loeb D.M.
        • Cody R.P.
        Arthrography of the wrist.
        J Bone Joint Surg. 1995; 77A: 1207-1210
        • Chung K.C.
        • Zimmerman N.B.
        • Travis M.T.
        Wrist arthrography versus arthroscopy: a comparative study of 150 cases.
        J Hand Surg. 1996; 21A: 591-594
        • Weiss A.C.
        • Akelman E.
        • Lambiase R.
        Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy.
        J Bone Joint Surg. 1996; 78A: 348-356
        • Golimbu C.N.
        • Firooznia H.
        • Melone C.P.
        • Rafii M.
        • Weinreb J.
        • Leber C.
        Tears of the triangular fibrocartilage of the wrist: MR imaging.
        Radiology. 1989; 173: 731-733
        • Cerofolini E.
        • Luchetti R.
        • Pederzini L.
        • Soragni O.
        • Colombini R.
        • D’Alimonte Piero
        • et al.
        MR evaluation of triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy.
        J Comput Assist Tomogr. 1990; 14: 963-967
        • Johnstone D.J.
        • Thorogood S.
        • Smith W.H.
        • Scott T.D.
        A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain.
        J Hand Surg Br. 1997; 22B: 714-718
        • Scheck R.J.
        • Kubitzek C.
        • Hierner R.
        • Szeimies U.
        • Pfluger T.
        • Wilhelm K.
        • 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
        • Oneson S.R.
        • Timins M.E.
        • Scales L.M.
        • Erickson S.J.
        • Chamoy L.
        MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation.
        AJR. 1997; 168: 1513-1518
        • Potter H.G.
        • Ernberg L.
        • Weiland A.
        • Hotchkiss R.N.
        • Peterson M.G.
        • McCormack R.R.
        The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist.
        J Bone Joint Surg. 1997; 79A: 1675-1684
        • Morley J.
        • Bidwell J.
        • Bransby-Zachary M.
        A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain.
        J Hand Surg Br. 2001; 26B: 544-546
        • Hiams A.H.
        • Schweitzer M.E.
        • Morrison W.B.
        • et al.
        Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist.
        AJR. 2002; 178: 419-422
        • Amrami K.K.
        Magnetic resonance arthrography of the wrist: case presentation and discussion.
        J Hand Surg. 2006; 31A: 669-672
        • Zanetti M.
        • Bram J.
        • Hodler J.
        Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI?.
        J Magn Reson Imaging. 1997; 7: 590-594
        • Bergin D.
        • Schweitzer M.E.
        Indirect magnetic resonance arthrography.
        Skeletal Radiol. 2003; 32: 551-558
        • Haims A.H.
        • Schweitzer M.E.
        • Morrison W.B.
        • et al.
        Internal derangement of the wrist: indirect MR arthrography verses unenhanced MR imaging.
        Radiology. 2003; 227: 701-797
        • Scheck R.J.
        • Romagnolo A.
        • Hierner R.
        • Pfluger T.
        • Wilhelm K.
        • Hahn K.
        The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy.
        J Magn Reson Imaging. 1999; 9: 468-474
        • Klein H.M.
        • Vrsalovic V.
        • Balas R.
        • Neugebauer F.
        Imaging diagnostics of the wrist: MRI and arthrography/arthro-CT.
        Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2002; 174: 177-182
        • Machiels F.
        • Moermans J.P.
        • Brutus J.P.
        Arthrographic and CT arthrographic findings in dorsal peripheral detachment of the triangular fibrocartilaginous complex.
        Jbr-Btr: Organe de la Societe Royale Belge de Radiologie. 2001; 84: 114-117
        • Schmid M.R.
        • Schertler T.
        • Pfirrmann C.W.
        • Wildermuth S.
        • Weishaupt D.
        Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging.
        Radiology. 2005; 237: 1008-1013