Accuracy of Wrist MRI in Detecting Synovitis and Correlation with Arthroscopy

Abstract

Hypothesis Wrist magnetic resonance imaging (MRI) has shown excellent diagnostic accuracy in evaluating soft-tissue pathology of the wrist including ganglion cysts, ligament tears, and triangular fibrocartilage complex (TFCC) pathology. However, it is unclear how often MRI detects synovitis that is subsequently encountered during wrist arthroscopy and may be a source of pain for patients with symptoms unresponsive to conservative treatment. The aim of this study is to assess the diagnostic accuracy of conventional MRI in the detection of wrist synovitis observed intraoperatively with wrist arthroscopy.

Materials and Methods A retrospective chart review was performed on 51 patients who underwent arthroscopy for chronic wrist pain and MRI confirmed wrist pathology that did not resolve with nonoperative treatment. Wrist arthroscopy was performed by three fellowship-trained hand surgeons. While the primary pathology like TFCC or scapholunate ligament tear was identified and treated arthroscopically, it was noted that many of the patients had concomitant synovitis observed arthroscopically that was not identified preoperatively on MRI. Therefore, the diagnosis of wrist synovitis on MRI scan was compared with the observed presence of synovitis at the time of wrist arthroscopy. Results of preoperative MRI without contrast were categorized as true positive, false positive, true negative, and false negative, based upon intraoperative arthroscopic findings.

Results In total, 45/51 patients were confirmed to have dorsal and ulnar synovitis on wrist arthroscopy. MRI identified 16/51 patients as having synovitis. Of those 16 patients, 2 were false positives.

Conclusion The results demonstrate that conventional MRI without contrast has poor diagnostic accuracy in detecting wrist synovitis. Patients with ligament or chondral pathology or no clearly identifiable pathology on MRI whose clinical symptoms persist despite conservative treatment may have underlying dorsal and ulnar wrist synovitis that is not detected on MRI. Wrist arthroscopy facilitates the identification and treatment of synovitis in patients with concomitant wrist pathology and pain refractory to nonoperative treatment. This study suggests that MRI may have a low sensitivity for identifying wrist synovitis when compared with wrist arthroscopy during the evaluation of patients presenting with wrist pain.

Keywords

wrist arthroscopy - synovitis - MRI

Disclosures

None.

Publication History

Received: 17 July 2023

Accepted: 29 January 2024

Article published online:
20 February 2024

• References

• 1 Nagle DJ. Evaluation of chronic wrist pain. J Am Acad Orthop Surg 2000; 8 (01) 45-55
• 2 DaSilva MF, Goodman AD, Gil JA, Akelman E. Evaluation of ulnar-sided wrist pain. J Am Acad Orthop Surg 2017; 25 (08) e150-e156
• 3 Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack Jr RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am 1997; 79 (11) 1675-1684
• 4 Daunt N, Couzens GB, Cutbush K, Green J, Ross M. Accuracy of magnetic resonance imaging of the wrist for clinically important lesions of the major interosseous ligaments and triangular fibrocartilage complex; correlation with radiocarpal arthroscopy. Skeletal Radiol 2021; 50 (08) 1605-1616
• 5 Smith TO, Drew B, Toms AP, Jerosch-Herold C, Chojnowski AJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. J Bone Joint Surg Am 2012; 94 (09) 824-832
• 6 Petsatodis E, Pilavaki M, Kalogera A, Drevelegas A, Agathangelidis F, Ditsios K. Comparison between conventional MRI and MR arthrography in the diagnosis of triangular fibrocartilage tears and correlation with arthroscopic findings. Injury 2019; 50 (08) 1464-1469
• 7 Golimbu CN, Firooznia H, Melone Jr CP, Rafii M, Weinreb J, Leber C. Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology 1989; 173 (03) 731-733
• 8 Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: a systematic review. Arthroscopy 2015; 31 (10) 2014-20.e2
• 9 Guermazi A, Hayashi D, Roemer FW. et al. Synovitis in knee osteoarthritis assessed by contrast-enhanced magnetic resonance imaging (MRI) is associated with radiographic tibiofemoral osteoarthritis and MRI-detected widespread cartilage damage: the MOST study. J Rheumatol 2014; 41 (03) 501-508
• 10 Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol 1997; 168 (06) 1513-1518
• 11 Vanden Eynde S, De Smet L, Fabry G. Diagnostic value of arthrography and arthroscopy of the radiocarpal joint. Arthroscopy 1994; 10 (01) 50-53
• 12 Adolfsson L. Arthroscopic synovectomy of the wrist. Hand Clin 2011; 27 (03) 395-399
• 13 Hobby JL, Tom BD, Bearcroft PW, Dixon AK. Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 2001; 56 (01) 50-57
• 14 Mohamadi A, Claessen FM, Ozkan S, Kolovich GP, Ring D, Chen NC. Diagnostic wrist arthroscopy for nonspecific wrist pain. Hand (N Y) 2017; 12 (02) 193-196
• 15 Schmauss D, Pöhlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K. Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 2016; 136 (06) 873-880
• 16 Hahn P, Häusler A, Bruckner T, Unglaub F. Wertigkeit der MRT hinsichtlich TFCC-Läsionen außerhalb klinischer Studien. [Quality rating of MRI regarding TFCC lesions in the clinical practice]. Handchir Mikrochir Plast Chir 2012; 44 (05) 310-313
• 17 Kuntz MT, Janssen SJ, Ring D. Incidental signal changes in the extensor carpi ulnaris on MRI. Hand (N Y) 2015; 10 (04) 750-755
• 18 Iordache SD, Rowan R, Garvin GJ, Osman S, Grewal R, Faber KJ. Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am 2012; 37 (01) 98-103
• 19 Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39 (09) 837-857
• 20 Scheck RJ, Kubitzek C, Hierner R. et al. The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy. Skeletal Radiol 1997; 26 (05) 263-271
• 21 Treiser MD, Crawford K, Iorio ML. TFCC injuries: meta-analysis and comparison of diagnostic imaging modalities. J Wrist Surg 2018; 7 (03) 267-272
• 22 Song IH, Althoff CE, Hermann KG. et al. Knee osteoarthritis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging. Ann Rheum Dis 2008; 67 (01) 19-25
• 23 Roemer FW, Guermazi A, Zhang Y. et al. Hoffa's fat pad: evaluation on unenhanced MR images as a measure of patellofemoral synovitis in osteoarthritis. AJR Am J Roentgenol 2009; 192 (06) 1696-1700
• 24 Ashman CJ, Farooki S, Abduljalil AM, Chakeres DW. In vivo high resolution coronal MRI of the wrist at 8.0 tesla. J Comput Assist Tomogr 2002; 26 (03) 387-391
• 25 Totterman SM, Miller R, Wasserman B, Blebea JS, Rubens DJ. Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 160 (01) 117-123
• 26 Wieners G, Detert J, Streitparth F. et al. High-resolution MRI of the wrist and finger joints in patients with rheumatoid arthritis: comparison of 1.5 tesla and 3.0 tesla. Eur Radiol 2007; 17 (08) 2176-2182