Scapholunate Interosseous Ligament Tears: Diagnostic Performance of 1.5 T, 3 T MRI, and MR Arthrography-A Systematic Review and Meta-analysis

RATIONALE AND OBJECTIVES

The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury.

MATERIALS AND METHODS

A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included.

RESULTS

Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25-42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P < 0.001) but not for 3.0 T MRI (chi-square: 8.00, P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1-51.4), 75.7% (66.8-83.2), and 82.1% (76.1-87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3-83.4), 97.1% (89.8-99.6), and 92.8% (90.2-94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71-11.39), 23.23 (3.16-171.00), and 65.04 (32.89-128.62) (P value < 0.001), respectively. The results were consistent after addressing publication bias and sensitivity analyses.

CONCLUSIONS

MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.

Three-Tesla MR imaging of the elbow in non-symptomatic professional baseball pitchers

OBJECTIVES

To retrospectively evaluate the qualitative and quantitative 3-T MR imaging features of the elbow in non-symptomatic professional baseball pitchers presenting as major league draft picks or trades.

MATERIALS AND METHODS

The Institutional Review Board (IRB) approved the HIPPA-compliant study. Informed consent was waived. Twenty-one professional non-symptomatic baseball pitchers (mean age 23, range 18 to 34 years old) underwent 3-T MR imaging of the pitching elbow. Two experienced readers independently performed qualitative (collateral ligaments, tendons, cartilage, bones, ulnar nerve, olecranon fossa, and joint fluid) and quantitative (collateral ligaments and posteromedial plica) evaluation. Descriptive statistics were calculated.

RESULTS

Collateral ligament thickening was seen in a high proportion, nearly half, however, without features of full thickness tearing. Tendinosis without tearing was seen in 19 % (4/21) of common extensors. Cartilage abnormalities were infrequent. Bone abnormalities manifested as edema in 24 % (5/21) and humeroulnar osteophytosis. Ulnar nerve signal and/or morphologic abnormalities were seen in a very high proportion, up to 81 % (17/21). The olceranon fat pad showed scarring features in about one third. The median ligament thicknesses in mm measured: 4.6 UCL anterior bundle, 1.8 UCL posterior bundle, 1.9 RCL, 2.5 LUCL, and 0.7 mm anular. The median plica dimensions were 5.3 by 2.2 by 2.7 mm.

CONCLUSION

High-resolution 3-T MR imaging frequently shows abnormalities involving the ligaments, tendons, nerves, olecranon fat pad, and bones in non-symptomatic baseball pitchers.

Chemical shift imaging: preliminary experience as an alternative sequence for defining the extent of a bone tumor

OBJECTIVE

To investigate chemical shift imaging (CSI) with in-phase and opposed-phase (OP) gradient-echo sequences as an alternative sequence to spin-echo T1 imaging for defining intra-medullary skeletal tumor extent.

METHODS AND MATERIALS

This retrospective HIPAA-compliant study was approved by our institutional institutional review board (IRB). Twenty-three subjects with histologically-proven tumors (17 appendicular, 6 axial) underwent magnetic resonance imaging (MRI) with T1-weighted spin echo (T1SE), fluid-sensitive, CSI, and contrast-enhanced T1 sequences. One observer recorded intra-medullary tumor extent (millimeters), with 153 total measurements on each sequence. Red marrow grade [0 (none), 1 (<50%), 2 (50-75%) and 3 (>75%)] in each bone was recorded. Tumor extent on different sequences was compared (Student's t-test); the impact of red marrow grade on measurements was assessed (Spearman's correlation coefficient).

RESULTS

There was good agreement between measurements of tumor extent on T1SE and CSI sequences in all cases (T1SE-CSI measurement difference range 0-13.2 mm, P>0.05). Measurements from other sequences were significantly different from those of T1SE (P<0.05). As red marrow grade in the bone increased, a significant increase in measurement difference obtained on T1SE and CSI sequences was observed (P<0.001).

CONCLUSIONS

CSI is a potential alternative technique to T1SE imaging for defining the intra-medullary extent of a bone tumor, possibly especially useful in regions with abundant red marrow.

ADVANCE IN KNOWLEDGE

CSI could be an alternative technique to T1SE imaging for defining the intra-medullary extent of bone tumor by abundant red marrow in the surrounding bone.