MRI of scapholunate ligament- comparison between direct MR arthrography and non-contrast examination with highresolution microscopy coil Poster No.: P-0115 Congress: ESSR 2015 Type: Authors: Keywords: DOI: Scientific Poster J. Prochazkova, A. Stouracova, A. Šprláková-Puková; Brno/CZ Musculoskeletal joint, Musculoskeletal system, MR, Arthrography, Athletic injuries 10.1594/essr2015/P-0115 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.essr.org Page 1 of 13
Purpose Scapholunate ligament damage, unless detected early, can lead to chronic pain and the development of wrist instability; it is clinically the most frequently diagnosed form of carpal instability in clinical practice. The aim of imaging methods is to provide the clinician with sufficient information about anatomical condition in the area, because accurate diagnostics of the wrist structure lesions is crucial for treatment strategy. The aim of this study is to compare high-resolution magnetic resonance imaging and direct artrography in detection of injuries to the scapholunate ligament. Methods and Materials In this prospective study a total of 47 patients, 25 men and 22 women, who showed clinical signs of wrist instability (chronic or acute) underwent both direct MRI artrography and native high-resolution MRI using 47mm microscopic coil. The average age of the patients was 30,7 years, within the range of 21-43 years. All of patients had pain in the wrist joint and during clinical examination and positive signs of instability were detected. Patients were examinated with the MR device Philips Achieva with field strength 1.5 Tesla using a microscopy coil (micro 47 grant coil); the examination was performed without contrast agent. The patients were examined in gantry with the limb along the body with palm facing the pad. The examination was performed on the coronal plane with T1 TSE and 3D SPIR sequence, on the sagittal plane with the PD SPAIR sequence and on the transversal plane with mffe WATS sequence (Tab.1). Table 1. Protocol of examination with a microscopy coil sequence plane FOV (mm) TR (ms) TE (ms) Flip angle 3D SPIR coronal 60 44 12 25 T1 TSE coronal 60 479 22 3D mffe axial 100 26 9.2 30 WATS PD SPAIR sagittal 80 2522 25 Page 2 of 13
Subsequently, the patients were examined with direct MR arthrography. In the magnetic resonance preparating room, mixture of contrast agent was applied into their radiocarpal joint area in aseptic conditions; the puncture was performed at the level of the joint cavity between the running of the tendons of the extensor policis longus muscle and extensor indicis muscle. Patients were examined in the identical position, with their hand along the body, but with the help of a 8-channel dedicated wrist coil (wrist coil 8). The examinations were performed sagittally with T1 TSE, coronally with T1 TSE, T1 TSE SPIR and PD sequence and transversally with 3D WATSf sequence (Tab.2). Table 2. Protocol of examination -direct MR arthrography sequence plane FOV (mm) TR (ms) TE (ms) Flip angle T1 TSE coronal 100 650 22 SPIR T1 TSE coronal 100 650 22 PD TSE coronal 100 3500 30 3D WATS axial 110 20 7.7 50 T1 TSE sagittal 120 500 15 Examinations were evaluated independently by two radiologist specialized in musculosceletal radiology and for evaluating ligament damage was used classification system based on Geissler arthroscopic classification of scapholunate lesions. IV-grade scale was used in the classification; grade I ligament was considered as undamaged, grade II with the changes of ligament signal but without its clear tear, grade III in partial ligament tear, with evaluation of localisation of tear - in the volar and/or dorsal portion of the scapholunate ligament; grade IV corresponds with complete ligament tear. The processing was performed in the software IBM SPSS Statistics, Version 21. For the summarization of classification correspondence, contingency tables were used. To assess the statistical significance of the relationship in the contingency table, Fisher's exact test was used; to evaluate the strength of the association, Cohen's kappa coefficient and Cramer's V coefficient were used. Results The findings between both methods - direct MR arthrography and non-contrast high resolution MR with a microscopy coil were evaluated in 44 cases. Three examinations Page 3 of 13
had to be excluded from the final evaluation due to motion artefacts.the results of both examinations coincided completely in 30 patients- in 8 findings without tear (grade I), in 4 findings of ligament non-homogeneity (grade II), in 9 findings of dorsal and/or volar tear (grade III) and 9 findings of complete tear of grade IV (Table 3). In ten cases the findings were overestimated, in four cases understated, which refers to the findings in our modified classification. All pathologies of the scapholunate ligament were described, in ten cases with varying degrees of classification. In four cases normal findings on SL ligament by direct MR arthrography were described as damaged in native high resolution MRI. Table 3. Comparison of results of the examination using a micro coil and MR arthrography. MR - micro coil Direct MR arthrography P<0.001 grade I grade II grade III grade IV micro coil total grade I 8 (66.7%) 8 (18.2%) grade II 4 (33.3%) 4 (50.0%) 3 (21.4%) 11 (25.0%) grade III 4 (50.0%) 9 (64.3%) 1 (10.0%) 14 (31.8%) grade IV 2 (14.3%) 9 (90.0%) 11 (25.0%) MR total arthro 12 (100.0%) 8 (100.0%) 14 (100.0%) 10 (100.0%) 44 (100.0%) Cohen's kappa coefficient equals 0.574 (p<0.001), implying that the correspondence of both methods is statistically significant. Cramer's V is equal to 0.672 (p<0.001), suggesting that there is a statistically significant association between these two methods. Images for this section: Page 4 of 13
Fig. 1: Non-contrast MR examination in high resolution, 3D SPIR sequence on coronal plane - the arrow marks SL ligament Page 5 of 13
Fig. 2: Non-contrast MR examination in high resolution, 3D mffe WATS on axial plane - the arrow marks SL ligament. Page 6 of 13
Fig. 3: Direct MR arthrography in the same patient, T1 TSE SPIR sequence on coronal plane - the arrow marks SL ligament. Page 7 of 13
Fig. 4: Direct MR arthrography in the same patient, 3D WATS sequence on axial plane - the arrow marks SL ligament. Page 8 of 13
Fig. 5: Non-contrast MR examination in high resolution, 3D SPIR sequence on coronal plane - the arrow marks SL ligament tear. Page 9 of 13
Fig. 6: Non-contrast MR examination in high resolution, 3D mffe WATS on axial plane - the arrow marks SL ligament tear. Page 10 of 13
Fig. 7: Direct MR arthrography in the same patient, T1 TSE SPIR sequence on coronal plane - the arrow marks SL ligament tear. Page 11 of 13
Fig. 8: Direct MR arthrography in the same patient, 3D WATS sequence on axial plane - the arrow marks SL ligament tear. Page 12 of 13
Conclusion MR imaging due to its great resolution ability undoubtedly belongs to diagnostic algorithm of scapholunate ligament lesionsthe optimum variant is the examination using MR arthrography, however for patients who doesn't tolerate interventional procedures is highresolution non-contrast MRI using microscopic coil great alternative without significant compromasing the quality. References Personal Information Page 13 of 13