Diagnostic performance of wrist magnetic resonance (MR) arthrography: Comparison of three-dimensional isotropic T₁ weighted fast spin-echo MR arthrography and two-dimensional MR arthrography

Objective: To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with twodimensional (2D) T₁ weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T₁ weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears. Methods: 26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T₁ weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated. Results: Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/ 88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent. Conclusion: In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T₁ weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T₁ weighted FSE D-MRA and that of 2D T₁ weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T₁ weighted FSE D-MRA has potential for substituting 2D imaging.