Original Communications
The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions*,**

https://doi.org/10.1053/jhsu.2001.24966Get rights and content

Abstract

This study investigates the effect of experience of the interpreter on the ability of magnetic resonance imaging (MRI) to identify the presence and anatomic location of a triangular fibrocartilage complex (TFCC) lesion. Fifty-one patients who underwent wrist arthroscopy with preoperative MRI studies were reviewed retrospectively. Two radiologists with different levels of training and experience evaluated the MRI scans in a blinded manner. The sensitivity rates of the 2 observers for detection of TFCC lesions were 86% and 80%. The specificity rates were 96% and 80%. The accuracy rates for prediction of a TFCC tear were 83% and 61% for the 2 observers. The correct location of a TFCC lesion was predicted by the more experienced observer for 12 of 19 central, 3 of 4 radial, and 6 of 12 peripheral lesions. The less experienced observer correctly identified 8 of 19 central, 2 of 4 radial, and 2 of 12 peripheral tears. The overall accuracy rates for prediction of a TFCC lesion and its location were 69% and 37%. Our data indicate that the published accuracy rates for prediction of TFCC lesion location may be reproducible only in very specialized centers. (J Hand Surg 2001;26A:742-748. Copyright © 2001 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

Patients were identified retrospectively from the databases of 3 fellowship-trained hand surgeons covering the period of 1992 to 1997. Inclusion criterion was an MRI scan performed before surgical wrist arthroscopy. All patients meeting this criterion were included unless they met one of the following exclusion criteria: prior wrist surgery, inability to determine the anatomic location of a TFCC lesion based on review of the surgical report, or the presence of a fracture or avascular necrosis

Results

The study included a total of 49 patients with 51 wrists evaluated by MRI and arthroscopy. Thirty-six wrists had arthroscopically confirmed TFCC tears; 15 patients underwent arthroscopy without evidence of full-thickness TFCC perforation. There were 19 central lesions, 12 peripheral lesions, and 4 radial lesions. The data are summarized in Tables 1 and 2.

. MRI Evaluation by ATTEND and Arthroscopic Findings

Empty CellArthroscopic Findings
MRI EvaluationNo TearCentralRadialPeripheralTotal
No tear1500116
Central3

Discussion

Imaging of TFCC continues to evolve. Arthroscopy, however, is invasive, requires an anesthetic, and the total costs associated with the procedure are greater. At our institution the difference in cost between a diagnostic wrist arthroscopy and MRI of the wrist is approximately $2,000. As the experience with wrist MRI has evolved, investigators have examined the ability of MRI to detect lesions of the ulnar side of the wrist. Initial reports comparing MRI and arthrography found that MRI was

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*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

**

Reprint requests: Philip E. Blazar, MD, Division of Orthopaedic Surgery, University of Kentucky, 740 South Limestone, K401 Kentucky Clinic, Lexington, KY 40536-0284.

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