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Accuracy of Community-Based Wrist MRI

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ABSTRACT

The accuracy of community-based magnetic resonance imaging (MRI) of the wrist compared to arthroscopic examination was evaluated. Literature reports of imaging accuracy are largely based on University center studies and presence of complete tears. In this study, multiple center MRI facilities were present due to regional insurance restrictions. Arthroscopic examination found a higher than reported incidence of incomplete interosseous ligament tears.

Twenty consecutive patients (9 men and 11 women) undergoing clinical, radiographic, MRI, and arthroscopic evaluation were included in the study. No patient had prior wrist surgery. A single hand surgeon examined all patients, reviewed all plain radiographs and MRIs, and performed all arthroscopic surgeries. The radiologist’s interpretation of MRI was compared to the arthroscopic findings. Patients with contrast and noncontrast MRI were included. All surgical reports described the triangular fibrocartilage complex, scapholunate, and lunotriquetral structures.

Average male and female patient age was 36 years and 34 years, respectively. Eleven patients had workers’ compensation and 9 had private insurance. Five (25%) of 20 MRIs had a false negative reading. No false positives were found. Fourteen (70%) of 20 patients had additional finds at arthroscopy that were not reported on MRI, which included 65% scapholunate tears, 15% lunotriquetral tears, and 40% triangular fibrocartilage complex tears. Of the scapholunate tears not reported, 4 were complete tears and 6 were incomplete. No complete lunotriquetral tears were noted; however, 3 incomplete lunotriquetral tears were reported. The overall sensitivity of MRI was 70% (14 of 20). Only 3 (15%) of 20 MRIs were 100% accurate.

In this metropolitan area, community-based MRIs are not as accurate as the literature reports when compared with arthroscopic findings. Partial tears of the scapholunate and lunotriquetral ligaments were frequently missed although suspected on clinical examination and confirmed by arthroscopy.