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Diagnostic Accuracy of Magnetic Resonance Imaging and Magnetic Resonance Arthrography for Triangular Fibrocartilaginous Complex Injury: A Systematic Review and Meta-Analysis

Smith, Toby O. BSc(Hons), MSc, MCSP; Drew, Benjamin BSc(Hons), MCSP; Toms, Andoni P. FRCS, FRCR; Jerosch-Herold, Christina DipCOT, MSc, PhD; Chojnowski, Adrian J. MB BChir, FRCS(Tr&Orth)

Journal of Bone & Joint Surgery - American Volume: 2 May 2012 - Volume 94 - Issue 9 - p 824–832
doi: 10.2106/JBJS.J.01775
Scientific Articles
Supplementary Content

Background: Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulnar-sided wrist pain and resultant functional disability. Diagnosis is based on the history and clinical examination as well as radiographic evidence of a TFCC central perforation or a radial/ulnar tear. The purpose of this study was therefore to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the detection of TFCC injury in the adult population.

Methods: Published and unpublished literature databases were searched. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary receiver operating characteristic curve evaluations were performed. The methodological quality of each study was assessed with use of the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool.

Results: Twenty-one studies were included in the review, and these series included a total of 982 wrists. On meta-analysis, MRA was superior to MRI in the investigation of full-thickness TFCC tears, with a pooled sensitivity of 0.75 and a pooled specificity of 0.81 for MRI compared with 0.84 and 0.95, respectively, for MRA. MRA and MRI performed at greater field strengths were reported to have greater sensitivity and specificity than those performed at lower field strengths. There were insufficient data to assess the diagnostic test accuracy for partial-thickness TFCC tears.

Conclusions: Given its acceptable diagnostic test accuracy, it is recommended that MRA, rather than MRI, be performed in when there are questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain.

Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Queen’s Building, School of Allied Health Professions, University of East Anglia, Norwich NR4 7TJ, United Kingdom. E-mail address for T.O. Smith:

2West Suffolk Hospital, Hardwick Lane, Bury St. Edmunds, Suffolk IP33 2QZ, United Kingdom

3Norfolk and Norwich Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, United Kingdom

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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