Bildgebende Diagnostik des Handgelenkes:
MRT und Arthrographie/Arthro-CT

 

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Zusammenfassung

Ziel: Die Untersuchung der diagnostischen Aussagekraft von Magnetresonanz-Tomographie (MRT), Arthrographie (AG) und Arthro-CT (ACT) bei Erkrankungen des Handgelenkes. Methodik: Insgesamt 346 Untersuchungen des Handgelenkes wurden für einen dreijährigen Beobachtungszeitraum retrospektiv ausgewertet. Es wurden 211 MRT, 151 Arthrographien (AG) und 126 Arthro-CT (ACT) durchgeführt. Alle Diagnosen wurden operativ (n = 78) oder durch den klinischen Verlauf in einer 6-monatigen Nachbeobachtung gesichert. Ergebnisse: Für die Diagnostik von Läsionen des diskoulnaren Komplexes lag die Sensitivität und Spezifität von AG, ACT und MRT über 0,96. Lediglich der positive Vorhersagewert differierte, allerdings nicht statistisch signifikant: Für die MRT lag er bei 0,94, für AG und ACT bei 0,99 resp. 0,98. In der Diagnostik traumatischer Verletzungen, speziell von Skaphoidfrakturen, war die MRT der AG und ACT deutlich überlegen. Ferner war die Möglichkeit der funktionellen Beurteilung in der AG wertvoll zur Diagnostik von ligamentären Defekten (n = 25). Schlussfolgerung: Für Erkrankungen des ulno-karpalen Komplexes ist bei hoher Zuverlässigkeit beider Verfahren die AG/ACT der MRT gering überlegen. In der Diagnostik von traumatischen und vaskulären Veränderungen ist die MRT der AG/ACT vorzuziehen.

Abstract

Purpose: To evaluate the use of magnetic resonance imaging (MRI) compared with arthrography and arthro-CT (AG/ACT) in patients with wrist pain. Methods: MRI and arthrography/arthro-CT (AG/ACT) of the wrist joint were retrospectively evaluated in 346 patients over a three-year period. Imaging findings were correlated to surgical results (n = 78) or clinical course in an at least 6-month follow-up. Results: For tears of the triangular fibrocartilage, arthrography, arthro-CT, and MRI demonstrated a sensitivity and specificity of more than 0.96. Only the positive predictive value was superior for arthrography/arthro-CT (0.99 and 0.98, respectively) compared with MRI (0.94). Arthrography was superior for functional diagnosis of scapho-lunate ligament tears (n = 25). Ulno-lunate and ulno-triquetral ligament defects were demonstrated more exactly by arthrography. Traumatic osseous defects, particularly scaphoid fractures (n = 33) and avascular necrosis (n = 17), were better diagnosed using MRI. Conclusion: For suspected lesions of the triangular fibrocartilage complex, AG/ACT is slightly more reliable than MRI. However, MRI was found to be highly accurate in diagnosing TFC tears, and is superior to AG/ACT in detecting traumatic and vascular lesions of the wrist.

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