Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma

Abstract

Purpose To investigate the role of ultrasound (US) in the evaluation of intrinsic and extrinsic ligaments of the wrist with magnetic resonance arthrography (MRA) as the reference standard.

Materials and Methods This prospective study included patients referred for MRA after wrist trauma. US examination was performed just before MRA. On the dorsal and palmar sides of the wrist, the intrinsic interosseus and midcarpal, extrinsic, and collateral ligaments were evaluated. MRA was performed on a 1.5-T unit. In the first 20 patients included, ligament thickness was independently assessed using US and MRA and thickness reproducibility was calculated. Ligament integrity was evaluated in all patients.

Results 38 patients (22 men, 16 women; mean age: 38 years) were included. Ligament thickness reproducibility ranged between 44% for the palmar ulnocapitate ligament and 71% for the palmar scaphotriquetral ligament. US had a sensitivity, specificity, positive and negative predictive values, and accuracy of 100% in the identification of tears of the palmar (n=8) and dorsal (n=3) bands of the scapholunate ligament and the ulnar collateral ligament (n=3). It had a sensitivity of 100%, specificity of 97%, positive predictive value of 50%, negative predictive value of 100%, and accuracy of 97% in the identification of tears of the palmar ulnolunate ligament (n=1).

Conclusion Compared to MRA, US showed good reproducibility in the assessment of wrist ligament thickness and similar accuracy with respect to identifying tears of the scapholunate, palmar ulnolunate, and ulnar collateral ligaments.

Zusammenfassung

Ziel Es sollte die Rolle des Ultraschalls (US) bei der Beurteilung der intrinsischen und extrinsischen Bänder des Handgelenks untersucht werden, wobei die Magnetresonanz-Arthrografie (MRA) als Referenzstandard diente.

Material und Methoden Diese prospektive Studie umfasste Patienten, die nach einem Handgelenktrauma zur MRA überwiesen wurden. Die US-Untersuchung wurde unmittelbar vor der MRA durchgeführt. Auf der dorsalen und palmaren Seite des Handgelenks wurden die intrinsischen interossären und mediokarpalen, die extrinsischen und die kollateralen Bänder bewertet. Die MRA wurde mit einem 1,5-T-Gerät durchgeführt. Bei den ersten 20 eingeschlossenen Patienten wurde die Dicke der Bänder unabhängig voneinander mittels US und MRA beurteilt und die Reproduzierbarkeit der Dicke berechnet. Die Integrität der Bänder wurde bei allen Patienten untersucht.

Ergebnisse 38 Patienten (22 Männer, 16 Frauen; Durchschnittsalter: 38 Jahre) wurden eingeschlossen. Die Reproduzierbarkeit der Ligamentdicke lag zwischen 44% beim palmaren Ligamentum ulnocapitatum und 71% beim palmaren Ligamentum scaphotriquetral. Die US-Untersuchung hatte eine 100%ige Sensitivität, Spezifität, positive und negative Vorhersagewerte und Genauigkeit bei der Identifizierung von Rissen der palmaren (n=8) und dorsalen (n=3) Bänder des Ligamentum scapholunatum und des Ligamentum collaterale ulnare (n=3). US hatte eine Sensitivität von 100%, eine Spezifität von 97%, einen positiven Vorhersagewert von 50%, einen negativen Vorhersagewert von 100% sowie eine Genauigkeit von 97% bei der Erkennung von Rissen des palmaren Ligamentum ulnolunatum (n=1).

Schlussfolgerung Im Vergleich zur MRA zeigte der US eine gute Reproduzierbarkeit bei der Beurteilung der Banddicke des Handgelenks und eine ähnliche Genauigkeit bei der Identifizierung von Rissen des Ligamentum scapholunatum, des palmaren Ligamentum ulnolunatum und des Ligamentum collaterale ulnare.

Keywords

carpal ligament - magnetic resonance arthrography - magnetic resonance imaging - ultrasound - wrist

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