The Value of the Distal Radioulnar Joint Effusion in Diagnosing Triangular Fibrocartilage Complex Tears on Magnetic Resonance Imaging

A retrospective study was conducted to evaluate the role of distal radioulnar joint (DRUJ) effusion inaiding the diagnostic accuracy of central triangular fibrocartilage complex (TFCC) tears on non-contrast MRI. 89 consecutive patients who had undergone wrist arthroscopy for ulna sided wrist pain in our unit wereidentified and their preoperative imaging reviewed. Two consultant musculoskeletal Radiologists independentlyreported the presence or absence of a DRUJ effusion and or a TFCC tear. The inter-observer variability was calculatedusing weighted Kappa tests. Two by two tables were constructed to calculate the sensitivity and specificity of reportedTFCC tear or DRUJ effusion on MRI in correctly diagnosing central TFCC tears identified at arthroscopy. Sensitivity of MRI to report a TFCC tear was 0.56 and specificity was 0.79. Sensitivity increased to 0.89if either a DRUJ effusion or TFCC tear were seen on MRI. When observed together, the presence of both a DRUJeffusion and a TFCC tear seen on the imaging lead to a sensitivity of 0.74 and PPV of 82% when compared tofindings at arthroscopy. In the absence of both DRUJ effusion and TFCC tear, the specificity of MRI increased to 0.92.Agreement by the radiologists on the presence of DRUJ effusion was substantial (k value 0.67) and TFCC tear wasmoderate (k value 0.58). The presence of DRUJ effusion on MRI can further improve sensitivity of MRI in diagnosing central TFCCtears. The sensitivity of detecting a central TFCC tear on MRI scan when both a DRUJ effusion and a TFCC tear wereseen (0.74) is comparable to rates demonstrated on MRA meta-analysis results (0.78). Furthermore, considering theabsence of both a DRUJ effusion and TFCC tear seen on MRI is useful in excluding the presence of a TFCC tear atarthroscopy.Level of evidence: III