[Scapholunate ligament tears in MR arthrography compared with wrist arthroscopy]

In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were prospectively examined with direct MR arthrography. Within 24 hours an arthroscopy of the wrist was performed. With MR arthrography in 21 patients or 17 % of all patients, injury of the scapho-lunate ligament was diagnosed. In all patients this could be verified arthroscopically. In the remaining 104 patients, no SL-ligament lesions were diagnosed with the MR arthrography. However, partial lesions were found via arthroscopy in seven cases and complete lesions of the ligament were found in one case, where MRI findings expected an intact SL ligament. In the remaining 96 cases, the MRI could correctly exclude a lesion of the SL-ligament. The diagnosis of a SL-ligament lesion by means of MRI was correct in 100 % of the cases (specificity), the exclusion of such lesions in 72 % (sensitivity). Positive or negative predictive values of 100 % or 92 % were achieved. Since a sensitivity of 100 % cannot be reached at the moment, MR arthrography cannot replace arthroscopy. However, it could be a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate the diagnostics and the indication for surgery of the wrist and help to reduce arthroscopic interventions for purely diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect a further increase of accuracy in the clinical use of the MR arthrography in the diagnostic workup of the wrist.