Validität der Magnetresonanztomographie bei der Diagnostik intraartikulärer Pathologien des Handgelenks
Vergleich mit der Arthroskopie als Referenzstandard
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Beschreibung
Intraarticular pathologies of the wrist affect patients’ everyday life and come along with loss in quality of life (Parr et al. 1989). Besides fractures, those pathologies include ruptures of ligaments and lesions of the cartilage. A sufficient and precise diagnostic wrap up is essential for adequate patient management (Dasilva et al. 2017). Besides clinical examination diagnostic wrap up includes non-invasive methods like X-ray, CT and MRI as well as the minimal-invasive arthroscopy (Adolfsson et al. 2004; Geissler et al. 1996). According to recent literature, technical innovations lead to higher diagnostic accuracy of MRI regarding evaluation of intraarticular pathologies which therefore is assumed to partially replace arthroscopy (Ochman et al. 2017).
Nevertheless, previous research is mainly based on prospective studies in a controlled setting, possibly not reflecting clinical routine (Anderson et al. 2008; Magee et al. 2009; Ochman et al. 2017). Therefore, the goal of this study was to evaluate validity of MRI in diagnostics of intraarticular pathologies of the wrist in a retrospective and possibly more realistic setting. Thus, reports of 319 clinically acquired MRI-scans and the corresponding arthroscopy were analyzed regarding major intraarticular pathologies using arthroscopy as reference standard. Furthermore, possible impact of several factors such as application of contrast agent or magnet field strength on the validity of MRI was analyzed.
With the heterogenous group of radiologists in this study reflecting clinical practice, only relatively low validities were obtained regarding validity in diagnostics of intraarticular wrist pathologies such as TFCC-lesions, ruptures of the SL-ligament, cartilage-lesions and synovitis. Technical modifications of the MR examination did not show any significant influence on these results. Interestingly, in conjunction with recent literature these results show, that MRI in general bears the potential to correctly identify intraarticular pathologies of the wrist, but this potential is not utilized sufficiently in clinical practice. Therefore, wide-ranging replacement of the arthroscopy by MRI seems to be unlikely in the near future. Nevertheless, conducting MRI in specialized radiologic centers with high expertise in musculoskeletal imaging could help exploit the potential of MRI in evaluation of intraarticular pathologies.
Autor*in
Johanna Luitjens
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Arthroskopie Gelenke Osteopathie