Direct traction MR imaging of the wrist: practical experience

Area of Science:

• Radiology
• Orthopedic Imaging
• Musculoskeletal MRI

Background:

• Magnetic Resonance Imaging (MRI) is crucial for diagnosing wrist pathologies.
• Optimizing image quality and diagnostic accuracy in wrist MRI remains an area of active research.
• Direct wrist traction is a technique that may alter joint mechanics and visibility.

Purpose of the Study:

• To evaluate the impact of direct wrist traction on patient-reported pain during MRI.
• To assess the effect of wrist traction on joint space width and cartilage visibility in wrist MRI.
• To determine if wrist traction improves the diagnostic accuracy for intrinsic ligament and triangular fibrocartilage complex tears.

Main Methods:

• A comparative study involving 291 patients undergoing wrist MRI, with 152 receiving direct wrist traction and 139 serving as a control group.
• Patients completed questionnaires to record pain scores before, during, and after the MRI examination.
• Radiographic assessments included joint space width, cartilage visibility, and diagnostic accuracy for specific wrist injuries based on subsequent arthroscopy findings.

Main Results:

• A higher proportion of patients in the traction group reported a slight increase in wrist pain (38% vs. 17%), though non-wrist pain prevalence was similar between groups.
• Direct wrist traction significantly increased average joint space width (0.6 mm wider, p < 0.001) and improved articular cartilage visibility (60% vs. 17% with moderate/good visibility, p < 0.001).
• Traction showed a trend towards increased diagnostic accuracy for intrinsic ligament tears, but this did not reach statistical significance (p = 0.136).

Conclusions:

• Direct wrist traction during MRI effectively increases joint space width and enhances articular cartilage visibility.
• While wrist traction may lead to a minor increase in patient-reported wrist pain, the benefits in image quality are significant.
• The findings suggest that wrist traction is a valuable adjunct for improving the diagnostic yield of wrist MRI, particularly for evaluating cartilage and ligamentous structures.