TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities
03 March 2017
26 December 2017
14 February 2018 (eFirst)
Background Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity.
Purpose This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries.
Methods A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the “gold standard.” A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries.
Results Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72–0.80), 0.78(0.70–0.84), and 0.89 (0.81–0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77–0.86), 0.85 (0.77–0.92), and 0.89 (0.81–0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions.
Conclusion This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.
- 1 Abe Y, Tominaga Y. Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports. Hand Surg 2011; 16 (02) 177-180
- 2 Bille B, Harley B, Cohen H. A comparison of CT arthrography of the wrist to findings during wrist arthroscopy. J Hand Surg Am 2007; 32 (06) 834-841
- 3 Blazar PE, Chan PS, Kneeland JB, Leatherwood D, Bozentka DJ, Kowalchick R. The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg Am 2001; 26 (04) 742-748
- 4 Cerofolini E, Luchetti R, Pederzini L. , et al. MR evaluation of triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy. J Comput Assist Tomogr 1990; 14 (06) 963-967
- 5 De Filippo M, Pogliacomi F, Bertellini A. , et al. MDCT arthrography of the wrist: diagnostic accuracy and indications. Eur J Radiol 2010; 74 (01) 221-225
- 6 De Smet L. Magnetic resonance imaging for diagnosing lesions of the triangular fibrocartilage complex. Acta Orthop Belg 2005; 71 (04) 396-398
- 7 Gabl M, Lener M, Pechlaner S, Judmaier W. The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex. J Hand Surg [Br] 1996; 21 (03) 311-314
- 8 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
- 9 Haims AH, Schweitzer ME, Morrison WB. , et al. Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology 2003; 227 (03) 701-707
- 10 Johnstone DJ, Thorogood S, Smith WH, Scott TD. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br] 1997; 22 (06) 714-718
- 11 Joshy S, Ghosh S, Lee K, Deshmukh SC. Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop 2008; 32 (02) 251-253
- 12 Lee RK, Ng AW, Tong CS. , et al. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol 2013; 42 (09) 1277-1285
- 13 Lee YH, Choi YR, Kim S, Song HT, Suh JS. Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging 2013; 31 (02) 221-226
- 14 Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 2009; 192 (01) 80-85
- 15 Mahmood A, Fountain J, Vasireddy N, Waseem M. Wrist MRI arthrogram v wrist arthroscopy: what are we finding?. Open Orthop J 2012; 6: 194-198
- 16 Moritomo H, Arimitsu S, Kubo N, Masatomi T, Yukioka M. Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2015; 40 (02) 245-251
- 17 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; 26 (06) 544-546
- 18 Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. Am J Roentgenol 1997; 168 (06) 1513-1518
- 19 Pahwa S, Srivastava DN, Sharma R, Gamanagatti S, Kotwal PP, Sharma V. Comparison of conventional MRI and MR arthrography in the evaluation wrist ligament tears: a preliminary experience. Indian J Radiol Imaging 2014; 24 (03) 259-267
- 20 Pederzini L, Luchetti R, Soragni O. , et al. Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy 1992; 8 (02) 191-197
- 21 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
- 22 Prosser R, Harvey L, Lastayo P, Hargreaves I, Scougall P, Herbert RD. Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study. J Physiother 2011; 57 (04) 247-253
- 23 Rüegger C, Schmid MR, Pfirrmann CW, Nagy L, Gilula LA, Zanetti M. Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol 2007; 188 (01) 187-192
- 24 Scheck RJ, 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 (03) 468-474
- 25 Schweitzer ME, Brahme SK, Hodler J. , et al. Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography. Radiology 1992; 182 (01) 205-211
- 26 Shih JT, Hou YT, Lee HM, Tan CM. Chronic triangular fibrocartilage complex tears with distal radioulna joint instability: a new method of triangular fibrocartilage complex reconstruction. J Orthop Surg (Hong Kong) 2000; 8 (01) 1-8
- 27 Shionova K, Nakamura R, Imaeda T, Makino N. Arthrography is superior to magnetic resonance imaging for diagnosing injuries of the triangular fibrocartilage. J Hand Surg [Br] 1998; 23 (03) 402-405
- 28 Tanaka T, Yoshioka H, Ueno T, Shindo M, Ochiai N. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury. J Hand Surg Am 2006; 31 (08) 1308-1314
- 29 Totterman SM, Miller RJ, McCance SE, Meyers SP. Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence. Radiology 1996; 199 (01) 227-232