Wrist

There is little literature assessing the effectiveness of CTA in diagnosing wrist joint disease. An early report assessed the value of double-contrast CTA in the evaluation of the triangular fibrocartilage complex (TFCC) [37]. This study used 2-mm-thick direct coronal wrist imaging to assess the TFCC following wrist arthrography. The study authors reported that the site of tear could be determined accurately from the CT examination, but that the CT study did not reveal any information not provided by the conventional arthrogram

[37]. A later study using single-contrast, triple-compartment arthrography

[38] showed that the sensitivity and specificity of standard arthrography and CTA were comparable, but that CT showed the site of tear with greater precision (Fig. 8). The CTA examinations showed sensitivities and specificities of 85% and 100% for the TFCC, 100% and 100% for the scapholunate (SL) ligament, and 80% and 100% for the lunotriquetral (LT) ligament [38].

The most recent study available compares the accuracy of multidetector row CTA with conventional MRI in depicting tears of the dorsal, central, and palmar segments of the SL and LT ligaments in cadaver specimens [39]. These investigators found that CTA and MRI were equivalent in their ability to detect central and palmar segment tears; however, CTA was significantly

Wrist Arthrogram

Fig. 8. (A) Single-contrast wrist arthrogram, frontal projection. Contrast injected into radio-scaphoid joint fills distal radioulnar (arrow) joint because of triangular fibrocartilage tear. (B) Coronal reformation from CTarthrogram, same patient. Radial attachment tear of the triangular fibrocartilage is documented clearly (arrowhead).

Fig. 8. (A) Single-contrast wrist arthrogram, frontal projection. Contrast injected into radio-scaphoid joint fills distal radioulnar (arrow) joint because of triangular fibrocartilage tear. (B) Coronal reformation from CTarthrogram, same patient. Radial attachment tear of the triangular fibrocartilage is documented clearly (arrowhead).

superior to MRI in detecting dorsal segment tears. Additionally, interobserver agreement was better for CTA (kappa = 0.37 to 0.78) than for conventional MRI (kappa = -0.33 to -0.10) [39].

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