The Impact of Radial MPR on Evaluation of TFCC Injury in CT Arthrography

Objective: Our goal was to analyze the diagnostic advantage of radial multiplanar reconstruction (MPR) for the detection of triangular fibrocartilage complex (TFCC) lesions in computed tomography (CT) arthrography.

Methods: A total of 102 patients received CT imaging of the wrist after undergoing three-compartment arthrography. In addition to standard MPRs (axial, coronal, and sagittal planes), we performed two radial reconstructions with the rotating center on top of the ulnar styloid process and ulnar fovea, respectively. Slice thickness was 1.0 mm, increment 0.5 mm with a field of view of 60 × 60 mm for all planes. In radial MPRs, the gap between images was 2 degrees. Two observers analyzed two randomized data sets for each CT arthrography scan. The first contained three standard planes; the second consisted of standard planes and two radial MPRs. After analyzing each data set, observers were asked for their evaluation of TFCC and diagnostic confidence on a 5-point Likert scale (1 = unsure; 5 = certain).

Results: TFCC lesions were present in 68 patients. The ulno-apical (“superficial”) insertion was affected in 21 cases, and the ulno-basal (“deep”) insertion presented discontinuity in 11 patients. The radial TFCC insertion was injured five times. Overall, 42 patients showed central TFCC lesions. When given the standard planes to work with, observers detected 93% of lesions with a diagnostic confidence of 3.1 (standard deviation [SD]: 0.9). With standard planes and radial MPRs, observers detected 95% of injuries with a diagnostic confidence of 4.2 (SD: 0.8). Interobserver reliability was high overall (r = 0.81; p < 0.05).

Conclusion: Our analysis shows that compared with evaluating only standard planes, the addition of radial reconstructions improves detection of TFCC lesions and diagnostic confidence in CT arthrography.