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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Jarvik JG, Dalinka MK, Kneeland JB. Hand injuries in adults. Semin Roentgenol. 1991;26(4):282-299. Review/Other-Dx N/A To discuss the role of the radiologists in the evalutation of soft tissue hand injuries in adults. No results stated in abstract. 4
2. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-915. Review/Other-Dx 1,465,874 cases To estimate the frequency and describe the epidemiology of hand and forearm fractures in the United States. In 1998 there were 1,465,874 estimated cases of hand/forearm fractures, accounting for 1.5% of all emergency department cases. Radius and/or ulna fractures comprised the largest proportion of fractures (44%). The most affected age group was 5 to 14 years of age (26%). Private insurance paid for 49% of the cases. Most of the fractures occurred at home (30%); the street/highway was the second most likely fracture location (14%). Accidental falls caused the majority (47%) of fractures. 4
3. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-125. Review/Other-Dx N/A To discuss the epidemiology of distal radius fractures. No results stated in abstract. 4
4. Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury. 2004;35(5):462-466. Review/Other-Dx 1688 individuals with a diagnosis of forearm fracture were identified To determine the extent of incidence and seasonal variation of fractures of the distal radius and compare our statistics with published data. There was a female:male ratio of 3.9:1. In women, the incidence of distal radius fracture rose from a premenopausal baseline of 10 per 10,000 population per year to a peak of 120 per 10,000 population per year over 85 years. In men, the fracture incidence gradually increased from 10 per 10,000 before 65 years to 33 per 10,000 after 85 years. 4
5. Chung KC, Shauver MJ, Yin H. The relationship between ASSH membership and the treatment of distal radius fracture in the United States Medicare population. J Hand Surg Am. 2011;36(8):1288-1293. Review/Other-Dx 47,405 beneficiaries To determine whether ASSH members use internal fixation at a higher rate and, if so, whether dedicated hand surgeons are the driving factor in the increased use of internal fixation procedures in the United States. Beneficiaries treated by ASSH members received internal fixation significantly more often than beneficiaries who were treated by surgeons who were not ASSH members. ASSH member status accounts for 12% of the total variance in internal fixation utilization. 4
6. Hyland-McGuire P, Guly HR, Hughes PM. Double take--fracture fishing in accident and emergency practice. J Accid Emerg Med. 1997; 14(2):84-87. Review/Other-Dx 55 patients To investigate conditions where, after initially negative plain x rays following trauma, there subsequently proves to be fracture, and to explore ways in which the management might be improved. 55 cases were identified: 41 fractures were identified on subsequent plain x ray, 6 on bone scan, 6 on CT scan, and 2 on MRI scan. The commonest regions involved were the wrist, pelvis/hip, ankle/foot, and leg. Follow-up had not been arranged at the initial attendance in 17 instances and between 2 and 135 days were required for definitive fracture recognition. All but 9 patients required alteration in treatment because of fracture detection. 4
7. Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am. 1997; 22(5):792-800. Observational-Dx 19 acute intra-articular distal radius fractures To evaluate the reliability of plain radiography vs CT for the measurement of small (<5 mm) intra-articular displacements of distal radius fracture fragments. CT showed more intra-articular displacements than radiographs. CT measurements of gap and step-off more reproducible than radiographic measurements. For displacements >2 mm, poor correlation between CT and radiographs. 2
8. Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am. 2006; 88(6):1315-1323. Observational-Dx 30 patients, 4 observers To determine whether 3D images improve the reliability and accuracy of fracture characterization and, secondarily, whether they influence the choice of treatment as compared with 2D images. 3D CT improved the intraobserver agreement, but not the interobserver agreement, regarding the presence of coronal plane fracture lines and central articular fragment depression. 3D CT improved both the intraobserver and the interobserver agreement regarding the presence of articular commination. Interobserver agreement increased when 3D CT was used to determine the exact number of articular fracture fragments. The sensitivity and accuracy of identifying specific fracture characteristics (as compared with intraoperative findings) improved when 3D imaging was used in conjunction with 2D imaging as compared with 2D imaging alone. The addition of 3D CT to 2D CT influenced treatment recommendations, resulting in a significantly greater number of decisions for an open approach (P<0.05) and combined dorsal and volar exposure (P<0.001). 2
9. Rodriguez-Merchan EC. Management of comminuted fractures of the distal radius in the adult. Conservative or surgical? Clin Orthop Relat Res. 1998; (353):53-62. Review/Other-Dx N/A Discuss treatment of distal radius fractures and determinants of outcomes. Early recognition and treatment of distal radioulnar joint injuries associated with fractures of the distal radius are paramount to reduce the incidence of painful sequelae and functional deficits. 4
10. Rozental TD, Bozentka DJ, Katz MA, Steinberg DR, Beredjiklian PK. Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture. J Hand Surg Am. 2001; 26(2):244-251. Review/Other-Dx 20 consecutive distal radius fractures To characterize the patterns of sigmoid notch involvement in displaced intra-articular distal radius fractures. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). Of the 13 fractures with sigmoid notch involvement, 9 (69%) were displaced and 4 (31%) were nondisplaced. Sigmoid notch articular step-off (n=7) and gapping (n=9) were detectable on the CT scans but not on the x-rays. 4
11. Gilbert TJ, Cohen M. Imaging of acute injuries to the wrist and hand. Radiol Clin North Am. 1997; 35(3):701-725. Review/Other-Dx N/A To review the basic characteristics of common fractures and dislocations in the hand and wrist. There is increasing recognition that fractures and dislocations of the hand and wrist can result in long-term pain and dysfunction. 4
12. Mack MG, Keim S, Balzer JO, et al. Clinical impact of MRI in acute wrist fractures. Eur Radiol. 2003; 13(3):612-617. Observational-Dx 54 patients (56 wrists) To determine clinical impact of MRI in traumatized wrists with normal or suspicious radiographs and clinical findings. In 31/56 wrists MRI findings resulted in a change of diagnosis. There were false-positive diagnoses on plain radiographs in nearly one-half (n=25) of the patients. False-negative diagnoses on plain radiographs resulted in 6 cases. MRI detected additional injuries of soft tissue in more than one third (n=20). In 22/56 wrists the period of immobilization could be shortened or ended, in 12/56 it was prolonged, and in 3/56 a surgical intervention was necessary. In 19 wrists MRI had no therapeutic consequences. 3
13. De Smet AA, Doherty MP, Norris MA, Hollister MC, Smith DL. Are oblique views needed for trauma radiography of the distal extremities? AJR Am J Roentgenol.1999; 172(6):1561-1565. Observational-Dx 1,461 consecutive radiographic examinations To determine whether the oblique view uniquely revealed abnormalities or clarified findings when it was obtained along with routine frontal and lateral radiographs. The examinations included 421 with abnormal findings, 34 with equivocal findings, and 1,006 with normal findings. The addition of the oblique view changed the interpretation in 70 (4.8%) of the 1,461 examinations. Of these changed interpretations, 39 were changed from equivocal to either positive or negative, 3 from positive to negative, and 28 from negative to positive. Addition of the oblique view increased diagnostic confidence: The percentage of examinations scored as having probably normal, equivocal, and probably abnormal findings decreased from 13.9% with two views to 8.4% with 3 views (P<.0001). The oblique view was equally valuable in the ankle, foot, toe, wrist, hand, finger, and thumb. 3
14. Russin LD, Bergman G, Miller L, et al. Should the routine wrist examination for trauma be a four-view study, including a semisupinated oblique view? AJR Am J Roentgenol. 2003; 181(5):1235-1238. Observational-Dx 54 wrist examinations To document the relative sensitivity of each of the four views for fracture detection and to assess whether it is beneficial to make the routine radiographic examination a 4-view study. The number of ulnar fractures reported by the four reviewers in the 54 examinations ranged from 15 to 20 (average, 18.3) The number of navicular fractures ranged from 1 to 6 (average, 3.8). The reviewers found fractures of the ulna and navicular bone more readily on the posteroanterior and posteroanterior oblique views than on the lateral and semisupinated oblique views They identified few fractures of the other carpal bones and metacarpals in the 54 examinations. 3
15. Street JM. Radiographs of phalangeal fractures: importance of the internally rotated oblique projection for diagnosis. AJR Am J Roentgenol. 1993; 160(3):575-576. Review/Other-Dx 12 patients To evaluate the value of an additional oblique view in finger fractures. Internally rotated oblique increased confidence in fracture detection. 4
16. Scalcione LR, Pathria MN, Chung CB. The athlete&#39;s hand: ligament and tendon injury. [Review]. Semin Musculoskelet Radiol. 16(4):338-49, 2012 Sep. Review/Other-Dx N/A To review the common ligamentous and tendinous injuries of the hand including collateral ligament injuries, gamekeeper's thumb, extensor mechanism injuries, pulley injuries, boutonniere deformities, and mallet and jersey lesions. No results stated in abstract. 4
17. McMurtry JT, Isaacs J. Extensor tendons injuries. Clin Sports Med. 2015;34(1):167-180. Review/Other-Dx N/A To review basic anatomy, and then discuss mallet finger injuries, boutonniere deformity, and sagittal band rupture. No results stated in abstract. 4
18. Kiuru MJ, Haapamaki VV, Koivikko MP, Koskinen SK. Wrist injuries; diagnosis with multidetector CT. Emerg Radiol. 2004; 10(4):182-185. Review/Other-Dx 38 patients To assess acute-phase MDCT findings in wrist injuries. MDCT revealed 56 fractures and 7 dislocations in 29 patients. In 9 patients (24%) MDCT findings were normal. 11 patients (29%) underwent surgical procedures. The main injury mechanism was a fall (58%). In 33 cases the primary radiograph was available. Compared to primary radiographs, MDCT revealed 9 occult fractures, mainly in small carpal bones. In 14 cases a suspected fracture (of the scaphoid in 7 cases) was ruled out by MDCT. Due to high-quality two-dimensional reformatting, MDCT examinations were not dependent on the wrist's position in the CT gantry. In the comparison with radiography, MDCT detected occult fractures and ruled out suspected fractures, both mainly in the small carpal bones. High-quality two-dimensional reformats gave significant information about the fracture anatomy. MDCT provides fast and valuable information in assessing complex wrist fractures or when the primary radiograph is equivocal. 4
19. Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med. 2015;34(1):37-50. Review/Other-Dx N/A To describe the management of scaphoid fractures in athletes. No results stated in abstract. 4
20. Khalid M, Jummani ZR, Kanagaraj K, Hussain A, Robinson D, Walker R. Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review. Emerg Med J. 2010;27(4):266-269. Review/Other-Dx 611 patients The study aims to 1. analyse the spectrum of diagnoses from a large consecutive series of MRI scans following a fall on an outstretched hand injury with normal plain x-rays. 2. assess the feasibility of performing the MRI scans in a timely manner. 3. examine available evidence with regard to the cost-effectiveness. There were 342 abnormal scans (56%) and 269 (44%) normal scans. Of the abnormal scans, 80% showed acute bony injuries, 8% showed acute soft tissue injuries and 12% showed incidental pathology. 4
21. Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med. 2003;31(6):1038-1048. Review/Other-Dx N/A To discuss the causes of hand and wrist injuries in sports and discusses pertinent biomechanical findings regarding the range of motion required in different sports activities. No results stated in abstract. 4
22. Shaftel ND, Capo JT. Fractures of the digits and metacarpals: when to splint and when to repair? Sports Med Arthrosc. 2014;22(1):2-11. Review/Other-Dx N/A To describe the management of athletes with fractures of the digits and the metacarpals. No results stated in abstract. 4
23. Nikken JJ, Oei EH, Ginai AZ, et al. Acute wrist trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment. Radiology. 2005; 234(1):116-124. Experimental-Dx 87 patients To assess predictive value of a short MRI examination in addition to or instead of radiography in patients with acute wrist trauma to identify patients who require additional treatment vs those who do not and can be discharged without further follow-up. 87 patients with acute wrist trauma randomized to radiography (n=43) or radiography and a short MRI examination with low-field-strength dedicated E-MRI (n=44). 36 patients had one or more fractures; one patient had a marked soft-tissue lesion. In univariable analysis, age (OR, 1.02; 95% CI: 1.00, 1.05), anatomic snuffbox tenderness (OR, 2.31; 95% CI: 0.90, 5.96), radiographic results (OR, 31.2; 95% CI: 8.90, 109), and positive MRI results vs MRI not performed (OR, 1.86; 95% CI: 0.57, 6.06) were significantly predictive of treatment need. In multivariable analysis, radiographic results (OR, 24.7; 95% CI: 6.59, 93.1) and positive MRI results (OR, 6.28; 95% CI: 1.27, 31.0) were significantly predictive of treatment need. Negative MRI results were not significantly predictive (OR, 0.87; 95% CI: 0.20, 3.82). 2
24. Nikken JJ, Oei EH, Ginai AZ, et al. Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial. Radiology. 2005; 236(3):958-967. Experimental-Dx 472 patients: 237 allocated to MRI strategy (MRI plus radiography), and 235 allocated to radiography alone To assess prospectively if a short imaging examination performed with low-field-strength dedicated MRI in addition to radiography is effective and cost saving compared with the current diagnostic imaging strategy (radiography alone) in patients with recent acute traumatic injury of the wrist, knee, or ankle. In the intervention group, quality of life for patients with knee injuries was significantly higher during the first 6 weeks, and time to completion of diagnostic workup was significantly shorter (mean, 3.5 days for intervention group vs 17.3 days for reference group). The number of additional diagnostic procedures was significantly lower in the intervention group vs the reference group (9 vs 35, respectively) for patients with knee injuries. Patients with knee injuries showed the largest difference in costs (intervention group, €1820 [$1,966]; reference group, €2231 [$2,409]) owing to a reduction in productivity loss. Costs were higher in patients with wrist injuries and almost equal in patients with ankle injuries. All cost differences, however, were not significant. 1
25. Remplik P, Stabler A, Merl T, Roemer F, Bohndorf K. Diagnosis of acute fractures of the extremities: comparison of low-field MRI and conventional radiography. Eur Radiol. 2004; 14(4):625-630. Observational-Dx 78 (41 fractures, 37 without fracture) patients To compare low-field MRI (0.2 T) and conventional radiography for the detection of acute fractures of the distal part of the extremities. The MRI and conventional radiography revealed a accuracy of 81.4% and of 79.5%, respectively, in the detection of acute fractures. The diagnostic accuracy of MRI to detect fractures in the hand and forefoot proved to be significantly inferior to conventional X-ray examinations. On the other hand, MRI achieved a better accuracy for the examination of bones near a large joint. The interobserver variability for both methods was rated as moderate. In ROC analysis both methods were rated as good. There was no statistical difference of the accuracy between low-field MRI and conventional radiography in the detection of acute fractures of the distal part of the extremities. 3
26. Catalano LW, 3rd, Barron OA, Glickel SZ. Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res. 2004; (423):79-84. Review/Other-Dx N/A Discuss measurement, imaging, and effect of articular incongruence in distal radius fractures. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intra-articular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. 4
27. Spence LD, Savenor A, Nwachuku I, Tilsley J, Eustace S. MRI of fractures of the distal radius: comparison with conventional radiographs. Skeletal Radiol. 1998; 27(5):244-249. Review/Other-Dx 21 consecutive inpatients To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid. Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. 10 patients (48%) had associated soft tissue injury: 6 patients had scapholunate ligament rupture, 2 patients had disruption of the triangular fibrocartilage, 1 patient had extensor carpi ulnaris tenosynovitis and 1 patient had a tear of a dorsal radiocarpal ligament. Of 5 patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. 4
28. Christiansen TG, Rude C, Lauridsen KK, Christensen OM. Diagnostic value of ultrasound in scaphoid fractures. Injury. 1991;22(5):397-399. Observational-Dx 103 patients To examine the diagnostic value of ultrasound when scaphoid fracture is suspected, and to establish the most suitable intensity, 0.5 and 2.0 W/cmZ, with application of a I MHz frequency for 30 s. Fracture was confirmed radiologically in 27. We found that the ultrasound test, applied with a frequency of 1 MHz and intensity of 0.5 W/cm2 and 2.0 W/cm2 for 30s, had a sensitivity of 37 per cent and a specificity of 61 per cent. 3
29. Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F. Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography. AJR Am J Roentgenol. 2002; 178(5):1239-1245. Observational-Dx 54 patients To evaluate the diagnostic accuracy of high-spatial-resolution US in the diagnosis of occult fractures of the waist of the scaphoid. Follow-up examinations proved fracture of the scaphoid waist in 5 patients. In all patients, diagnosis of fracture was suspected on initial US showing cortical disruption associated with soft-tissue abnormalities. There was one false-positive finding and no false-negative results. Using cortical disruption as a diagnostic criterion, the sensitivity, specificity, and accuracy of high-resolution US for the depiction of scaphoid fracture were 100%, 98%, and 98%, respectively. Using soft-tissue abnormalities alone as a criterion, the sensitivity, specificity, and accuracy of high-resolution US were 100%, 65%, and 68%, respectively. The overall prevalence of occult fracture was 9%, ranging from 3.7% for low suspicion to 27% for high suspicion of fracture. 3
30. Ramamurthy NK, Chojnowski AJ, Toms AP. Imaging in carpal instability. J Hand Surg Eur Vol. 2016;41(1):22-34. Review/Other-Dx N/A To review level-III studies evaluating the role of imaging in carpal instability. No results stated in abstract. 4
31. Tischler BT, Diaz LE, Murakami AM, et al. Scapholunate advanced collapse: a pictorial review. Insights Imaging. 2014;5(4):407-417. Review/Other-Dx N/A To provide a pictorial review of the anatomy of the scapholunate interosseous ligament as well as the common terminology and biomechanical alterations seen in the pathway leading to the development of SLAC arthropathy. No results stated in abstract. 4
32. Moser T, Dosch JC, Moussaoui A, Buy X, Gangi A, Dietemann JL. Multidetector CT arthrography of the wrist joint: how to do it. Radiographics. 2008;28(3):787-800; quiz 911. Review/Other-Dx N/A Review use of MDCT arthrography of the wrist joint. MDCT arthrography is useful in the diagnosis and evaluation of different articular disorders. Main limitation is in evaluation of soft-tissue abnormalities; addition of US or MRI might help. 4
33. Moser T, Dosch JC, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 2007;188:1278-86. Observational-Dx 45 patients, 12 phantom for contrast selection 2 observers In vitro and in vivo study to evaluate MRI and combination of MDCT arthrography and MR arthrography (one injection) for diagnosis of wrist ligament tears and cartilage abnormalities, with clinical and operative follow-up. Complete SL and LT tears defined as involving all 3 (dorsal, central, volar) segments; partial defined as involving 1 or 2 segments. Sensitivity and specificity calculated for multiple anatomic sites (SL, LT, TFCC) and observers, with SL and LT ligaments evaluated equally well by all three techniques; however, CT arthrography best for partial tears (SL, LT), TFCC tears, and cartilage abnormalities, and statistically significantly better than MRI; MR arthrography more sensitive than MRI but not statistically significant. Sensitivity: CTA > MRA > MRI, especially for articular cartilage defects, ulnar-sided TFCC tears, and partial SL and LT ligament tears. 1
34. Bille B, Harley B, Cohen H. A comparison of CT arthrography of the wrist to findings during wrist arthroscopy. J Hand Surg Am. 2007;32(6):834-841. Observational-Dx 72 patients To determine the accuracy of computed tomography after wrist arthrogram (CT arthrogram) compared with findings during wrist arthroscopy as interpreted by a musculoskeletal radiologist and a board-certified hand surgeon. Sixteen SLIL tears, 29 LTIL tears, 10 peripheral TFCC tears, and 33 central TFCC tears were identified at the time of wrist arthroscopy. Sensitivity and specificity of the CT arthrogram were calculated using arthroscopy findings as our reference standard. The radiologist's readings (sensitivity, specificity) revealed the following: SLIL (94%, 86%), LTIL (85%, 79%), peripheral TFCC (30%, 94%), and central TFCC (88%, 95%). Results of CT arthrogram readings by the hand surgeon were SLIL (94%, 82%), LTIL (97%, 81%), peripheral TFCC (40%, 97%), and central TFCC (91%, 85%). 2
35. Schmitt R, Froehner S, Coblenz G, Christopoulos G. Carpal instability. Eur Radiol. 2006;16(10):2161-2178. Review/Other-Dx N/A To review the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. No results stated in abstract. 4
36. Lee YH, Choi YR, Kim S, Song HT, Suh JS. Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging. 2013;31(2):221-226. Observational-Dx 48 patients To validate the diagnostic performance of high-resolution isovolumetric magnetic resonance arthrography (MRA) for intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist as compared to conventional MR imaging (MRI). Arthroscopy revealed 37 TFCC central tears, 15 TFCC peripheral tears, 20 SLIL tears and 13 LTIL tears. Sensitivities of MRI and MRA were 70.3% and 94.6% for detection of TFCC central tears, 60.0% and 93.3% for detection of TFCC peripheral tears, 65.0% and 85.0% for SLIL tears, and 61.5% and 84.6% for LTIL tears. The specificity of the MRI was 100% for the detection of ligaments and TFCC tears. The specificities of the MRA for detection of TFCC central tears, TFCC peripheral tears, SLIL tears and LTIL tears were 100%, 97%, 96.4% and 100%, respectively. 3
37. Toms AP, Chojnowski A, Cahir JG. Midcarpal instability: a radiological perspective. Skeletal Radiol. 2011;40(5):533-541. Review/Other-Dx N/A To examine the role of diagnostic imaging in the management of midcarpal instability. No results statedin abstract. 4
38. Chhabra A, Soldatos T, Thawait GK, et al. Current perspectives on the advantages of 3-T MR imaging of the wrist. Radiographics. 2012;32(3):879-896. Review/Other-Dx N/A To review the basic concepts of MR imaging of the wrist, while emphasizing the advantages of 3-T imaging systems for detecting abnormalities in carpal structures. No results stated in abstract. 4
39. Hobby JL, Tom BD, Bearcroft PW, Dixon AK. Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol. 2001;56(1):50-57. Review/Other-Dx 11 studies To review the published diagnostic performance statistics for magnetic resonance imaging (MRI) of the wrist for tears of the triangular fibrocartilage complex, the intrinsic carpal ligaments, and for osteonecrosis of the carpal bones. We identified 11 studies reporting the diagnostic performance of MRI for tears of the triangular fibrocartilage complex for a total of 410 patients, six studies for the scapho-lunate ligament (159 patients), six studies for the luno-triquetral ligament (142 patients) and four studies (56 patients) for osteonecrosis of the carpal bones. 4
40. Anderson ML, Skinner JA, Felmlee JP, Berger RA, Amrami KK. Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am. 2008;33(7):1153-1159. Observational-Dx 102 patients To evaluate the diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. A tear of the TFCC was identified retrospectively on 1.5T images in 49 of 58 patients and on 3.0T images in 15 of 16 patients. Compared with the gold standard of arthroscopy, 1.5T wrist MRI in this patient population had a sensitivity of 85%, a specificity of 75%, and an accuracy of 83% for reader 1 for the detection of a tear of the TFCC. In the same patient population, 3.0T wrist MRI had a sensitivity of 94%, a specificity of 88%, and an accuracy of 91% for reader 1. For reader 2, the improvement in sensitivity for the lunotriquetral ligament between the 1.5T and 3.0T images was statistically significant. The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI. The trend suggests that 3.0T wrist MRI provides improved capability for detection of TFCC injuries. Given the available sample size, however, the confidence intervals around the point estimates are wide and overlapping. Further studies are needed to confirm or refute our results of the estimated sensitivity, specificity, and accuracy parameters. 2
41. Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 2009;192(1):80-85. Observational-Dx 300 consecutive patients To assess the sensitivity and specificity of MRI at 3 T compared with arthroscopy for detection of intrinsic wrist ligament and triangular fibrocartilage complex (TFCC) tears. MR sensitivity for detection of TFCC tears was 86%, for detection of scapholunate tears was 89%, and for detection of lunatotriquetral tears was 82%. MR specificity for detection of tears was 100%. MR arthrography sensitivity for detection of ligament and TFCC tears was 100%. There were three patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients underwent arthroscopy with no tears seen. MRI at 3 T is sensitive and specific for detection of wrist ligament tears. MR arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations. 2
42. Spaans AJ, Minnen P, Prins HJ, Korteweg MA, Schuurman AH. The value of 3.0-tesla MRI in diagnosing scapholunate ligament injury. J Wrist Surg. 2013;2(1):69-72. Observational-Dx 37 patients To determine the sensitivity and specificity of 3.0-tesla (T) magnetic resonance imaging (MRI) and a dedicated hand coil in diagnosing scapholunate ligament (SLL) injury compared with intraoperative findings. An SLL lesion was identified during arthrotomy in 37 wrists. The first radiologist identified an SLL lesion on MRI in 26 wrists, all of which were confirmed intraoperatively. The second radiologist identified SLL lesions in 31 patients; however, intraoperatively it was found that there was no lesion of the ligament in one patient. Sensitivity ranged from 70 to 81% with a specificity of 100% and a positive predictive value of 97 to 100%. Accuracy measured 71 to 79%. 2
43. Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39(9):837-857. Review/Other-Dx N/A Imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. No results stated in abstract. 4
44. Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR Imaging and US of the Wrist Tendons. [Review]. Radiographics. 36(6):1688-1700, 2016 Oct. Review/Other-Dx N/A To review the normal appearance of the wrist tendons, discuss relevant anatomy, and give an overview of common pathologic conditions affecting the wrist tendons. No results stated in abstract. 4
45. Haims AH, Schweitzer ME, Morrison WB, et al. Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology. 2003;227(3):701-707. Observational-Dx 86 wrists; 3 observers Compare indirect MR arthrography with unenhanced MRI of the wrist for evaluation of the central disk of the TFCC and the SL and LT interosseous ligaments. For evaluation of the central disk of the TFCC sensitivities and specificities were 54%-73% and 83%-91%, respectively with no significant difference between indirect MR arthrography (P=.666) and unenhanced MRI (P=.559). For SL ligament, sensitivities and specificities were 38%-69% and 75%-99%, respectively, with improvement in sensitivity at indirect MR arthrography (P=.017) and no significant difference in specificity (P=.876). For LT ligament, sensitivities were 0%-22%, specificities were 88%-99%, with no significant difference between indirect MR arthrography and unenhanced MRI (P=.592 and P=.354, respectively, for sensitivity and specificity. 3
46. Scheck RJ, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K. The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging. 1999;9(3):468-474. Observational-Dx 35 patients To assess the value of three-compartment magnetic resonance (MR) wrist arthrography in comparison with non-enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments. The delineation of individual wrist ligaments was rated as "good" in 10% of non-enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non-enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full-thickness ligamentous defects were 0.81/0.75/0.77 for non-enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. The findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist. 2
47. Braun H, Kenn W, Schneider S, Graf M, Sandstede J, Hahn D. [Direct MR arthrography of the wrist- value in detecting complete and partial defects of intrinsic ligaments and the TFCC in comparison with arthroscopy]. Rofo. 2003;175(11):1515-1524. Observational-Dx 75 patients To assess the value of two-compartment magnetic resonance (MR) wrist arthrography in comparison with diagnostic arthroscopy for the evaluation of defects of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments in patients with refractory wrist pain. Twenty-five complete and 47 partial defects were detected arthroscopically (TFCC: 21/20, scapholunate ligament: 3/18, lunotriquetral ligament: 1/9). The TFCC showed a higher prevalence for degenerative lesions (11 type 2C-lesions and 20 type 2A/B lesions) than for traumatic lesions (5 type 1A lesions, 5 type 1D lesions). For direct MR arthrography, the obtained sensitivities and specificities in assessing complete defects were 96 % and 99.6 % (T (1)-weighted SE) and 92 % and 100 % (FLASH 3D), respectively. For all partial defects, sensitivities and specificities were 68.1 % and 93.3 % (T (1)-weighted SE) and 63 % and 96.1 % (FLASH 3D), respectively. For depicting partial defects of the scapholunate ligament the T (1)-weighted SE sequence (83.3/95.5 %) was superior to the FLASH 3D sequence (64.7/96.6 %), p < 0.05. For the evaluation of the TFCC (T (1)-weighted SE: 65/94.4 %, FLASH 3D: 70/94.6 %) and the lunotriquetral ligament (T (1)-weighted SE: 44/89.4 %, FLASH 3D: 44 /96.7 %), direct MR arthrography showed an insufficient correlation with arthroscopy. 2
48. Manton GL, Schweitzer ME, Weishaupt D, et al. Partial interosseous ligament tears of the wrist: difficulty in utilizing either primary or secondary MRI signs. J Comput Assist Tomogr. 2001;25(5):671-676. Observational-Dx 50 patients To evaluate the accuracy of MR and the usefulness of secondary MR signs to diagnose partial interosseous ligament tears. Arthroscopically, there were 16 SLL and 14 LTL partial tears. Accuracy of primary MR signs of partial tears was lower than that described in the literature for complete tears [sensitivity/specificity (kappa) = 0.56/0.56 (0.12)-SLL, 0.31/0.76 (0.13)-LTL]. Secondary signs showed low sensitivity but high specificity, particularly for LTL tears: arc disruption [0.17/0.83 (0.43)-SLL, 0.0/1.00 (1.0)- LTL], focal osteoarthritis [0.32/0.78 (0.18)-SLL, 0.11/0.91 (0.12)-LTL], and focal osseous offset [0.39/0.75 (0.10)-SLL, 0.26/0.93 (0.39)-LTL]. Additionally, there was poor interobserver consistency for both primary and secondary signs. 2
49. Boutry N, Lapegue F, Masi L, Claret A, Demondion X, Cotten A. Ultrasonographic evaluation of normal extrinsic and intrinsic carpal ligaments: preliminary experience. Skeletal Radiol. 2005;34(9):513-521. Review/Other-Dx 20 cadaveric wrists To determine normal anatomy of extrinsic and intrinsic carpal ligaments at ultrasonography (US). With regard to extrinsic carpal ligaments, the radioscaphocapitate ligament (partially visible, 38%; completely visible, 62%), the radiolunotriquetral ligament (partially visible, 27%; completely visible, 73%), the palmar ulnotriquetral ligament (partially visible, 12%; completely visible, 88%), and the dorsal radiotriquetral ligament (partially visible, 7%; completely visible, 93%) were visualized at US. The dorsal ulnotriquetral ligament (partially visible, 21%; completely visible, 74%), the ulnolunate ligament (partially visible, 5%; completely visible, 70%), and the radial collateral ligament (partially visible, 18%; completely visible, 12%) were more difficult to recognize. The radioscapholunate ligament was never seen. With regard to intrinsic carpal ligaments, the dorsal (partially visible, 11%; completely visible, 89%) and palmar (partially visible, 38%; completely visible, 62%) scaphotriquetral ligaments as well as the dorsal scapholunate ligament (partially visible, 3%; completely visible, 97%) were visualized at US. The dorsal lunotriquetral ligament (partially visible, 39%; completely visible, 61%) and the palmar scapholunate ligaments (partially visible, 12%; completely visible, 81%) were more difficult to recognize. 4
50. Taljanovic MS, Goldberg MR, Sheppard JE, Rogers LF. US of the intrinsic and extrinsic wrist ligaments and triangular fibrocartilage complex--normal anatomy and imaging technique. Radiographics. 2011;31(1):e44. Review/Other-Dx N/A Review role of US in imaging of intrinsic and extrinsic wrist ligaments and triangular fibrocartilage complex. Promising results have been published on US and sonoarthrography of the intrinsic wrist ligaments and the triangular fibrocartilage complex and on US of the majority of extrinsic wrist ligaments. Visualization of these structures can be achieved by using high-frequency linear transducers. 4
51. Dao KD, Solomon DJ, Shin AY, Puckett ML. The efficacy of ultrasound in the evaluation of dynamic scapholunate ligamentous instability. J Bone Joint Surg Am. 2004;86-A(7):1473-1478. Observational-Dx 64 wrists To determine the efficacy of ultrasound in the diagnosis of dynamic scapholunate ligamentous instability. Over a period of 1.5 years, a total of sixty-four wrists were evaluated in fourteen patients (Group A) and eighteen normal subjects (Group B). All fourteen nonaffected wrists in Group A and all thirty-six wrists in Group B were correctly identified as normal with use of ultrasound. Of the fourteen affected wrists in Group A, thirteen were found to have scapholunate ligament laxity on the basis of arthroscopy (twelve wrists) or arthrotomy (one wrist); six of these thirteen wrists had been correctly identified as abnormal with use of ultrasound (a true-positive result), and seven had false-negative results. There was one true-negative result. The ability of ultrasound to differentiate between normal and abnormal wrists was significant (p < 0.001). For the sixty-four wrists, statistical analysis revealed that ultrasound had a sensitivity of 46.2%, a specificity of 100%, and an accuracy of 89.1%. 2
52. Finlay K, Lee R, Friedman L. Ultrasound of intrinsic wrist ligament and triangular fibrocartilage injuries. Skeletal Radiol. 2004;33(2):85-90. Observational-Dx 26 patients To evaluate ultrasound as a diagnostic tool for investigating scapholunate and lunatotriquetral ligamentous and triangular fibrocartilage (TFC) tears. All ten scapholunate tears confirmed on arthrography were detected on ultrasound. Two of 8 lunatotriquetral and 7 of 11 TFC tears were correctly diagnosed on ultrasound. Sensitivity of ultrasound diagnosis ranged from 25% for lunatotriquetral tears to 100% for scapholunate tears. No false positive results were recorded for any of the three examined structures. 3
53. Taljanovic MS, Sheppard JE, Jones MD, Switlick DN, Hunter TB, Rogers LF. Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography. J Ultrasound Med. 2008;27(2):179-191. Observational-Dx 16 patients Prospective study to determine the value of US and sonoarthrography in evaluation of dorsal bands of the SL ligament, LT ligament, and TFCC disk in correlation with arthrography and MR arthrography. For SLL, results were concordant for all imaging modalities in 15 patients (93.75%) and partially concordant in 1 (6.25%). For LTL, results were concordant for all imaging modalities in 12 patients (75%), partially concordant in 3 (18.75%), and discordant in 1 (6.25%). For TFCC, the results were concordant for all imaging modalities in 13 patients (81.25%), partially concordant in 2 (12.5%), and discordant in 1 (6.25%). The arthroscopic and imaging findings were concordant for 3 SLL, 3 LTL, and 3 TFCC disks. 3
54. Squires JH, England E, Mehta K, Wissman RD. The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna. AJR Am J Roentgenol. 2014;203(1):146-153. Review/Other-Dx N/A To review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. No results stated in abstract. 4
55. Scalcione LR, Gimber LH, Ho AM, Johnston SS, Sheppard JE, Taljanovic MS. Spectrum of carpal dislocations and fracture-dislocations: imaging and management. AJR Am J Roentgenol. 2014;203(3):541-550. Review/Other-Dx N/A To discuss the imaging of carpal dislocations and fracture-dislocations and to review the ligamentous anatomy of the wrist, mechanisms of injury, and routine management of these injuries. No results stated in abstract. 4
56. Cerezal L, de Dios Berna-Mestre J, Canga A, et al. MR and CT arthrography of the wrist. Semin Musculoskelet Radiol. 2012;16(1):27-41. Review/Other-Dx N/A To describe diagnostic approaches that allow assessment of ligaments and the TFC complex. No results stated in abstract. 4
57. Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology. 279(3):674-92, 2016 Jun. Review/Other-Dx N/A To review the most common hand and wrist sports-related lesions. No results stated in abstract. 4
58. Drape JL, Tardif-Chastenet de Gery S, Silbermann-Hoffman O, et al. Closed ruptures of the flexor digitorum tendons: MRI evaluation. Skeletal Radiol. 1998;27(11):617-624. Observational-Dx 10 patients To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. 3
59. Rawat U, Pierce JL, Evans S, Chhabra AB, Nacey NC. High-Resolution MR Imaging and US Anatomy of the Thumb. Radiographics 2016;36:1701-16. Review/Other-Dx N/A To provide a clear understanding of the complexities associated with imaging the normal thumb anatomy. No results stated in abstract. 4
60. Hinke DH, Erickson SJ, Chamoy L, Timins ME. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb). AJR Am J Roentgenol. 1994; 163(6):1431-1434. Review/Other-Dx 3 volunteers, 2 cadaveric specimens, and 11 patients with acute injury To determine the MRI appearance of the UCL of the thumb in cadavers and volunteers and to analyze the MRI findings in patients with gamekeeper's thumb, especially with regard to the value of MRI in detecting clinically significant displacement of the ligament (Stener lesion). MRIs showed rupture of the UCL in all 11 patients. Prospectively, Stener lesions (n=3) could be differentiated from non-Stener lesions (n=8) in 8/11 patients. Retrospectively, the correct diagnosis could be made in all 11 patients once the importance of determining the position of the UCL relative to the adductor aponeurosis was understood. 4
61. Parellada JA, Balkissoon AR, Hayes CW, Conway WF. Bowstring injury of the flexor tendon pulley system: MR imaging. AJR Am J Roentgenol. 1996;167(2):347-349. Observational-Dx 3 patients To describe the flexor tendon pulley system and present our MR technique. Rupture of the tendon pulley system was diagnosed in all three cases by noting bow stringing of the tendon on the flexion images (Fig. 2) compared with normal apposition of the flexor tendons to the underlying bone in the adjacent digit (Fig. 3). Surgical 3
62. Hergan K, Mittler C, Oser W. Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US and MR imaging. Radiology. 1995; 194(1):65-71. Observational-Dx 17 patients To compare the usefulness of US and MRI in the differentiation of displaced and nondisplaced tears of the UCL. The results of US were correct in 15 patients, but displaced and nondisplaced ruptures were misinterpreted in 2 patients (sensitivity, 88%; specificity, 83% for displaced, 91% for nondisplaced). Sensitivity and specificity were both 100% for MRI. The T2-weighted sequence was more useful because the normal UCL is rarely homogeneously hypointense. 3
63. Spaeth HJ, Abrams RA, Bock GW, et al. Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress. Radiology. 1993;188(2):553-556. Observational-Dx 29 cadaver hands The use of MRI in the evaluation of UCL injury. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement. 2
64. Ebrahim FS, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA. US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics. 2006;26(4):1007-1020. Review/Other-Dx N/A To outline a simple method of performing US of the thumb and discuss the spectrum of common acute disorders encountered with particular emphasis on UCL injuries. No results stated in abstract. 4
65. Martinoli C, Perez MM, Bignotti B, et al. Imaging finger joint instability with ultrasound. [Review]. Semin Musculoskelet Radiol. 17(5):466-76, 2013 Nov. Review/Other-Dx N/A To review the spectrum of joint injuries of the thumb and fingers that are common in the athletic population with a main focus on the ultrasound features of collateral ligament tears, palmar plate injuries, and thumb sesamoid fractures. No results stated in abstract. 4
66. Klauser A, Frauscher F, Bodner G, et al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology. 2002;222(3):755-761. Observational-Dx 64 patients To determine the ability of dynamic ultrasonography (US) to depict finger pulley injuries in extreme rock climbers. US depicted 16 (100%) of 16 complete A2 pulley ruptures, nine (100%) of nine complete A4 pulley ruptures, six (86%) of seven surgically proved complete combined A2 and A3 pulley ruptures, and 15 (100%) of 15 incomplete A2 pulley ruptures. Measurement of distance between the flexor tendon and phalanx was significantly different among patient subsets without pulley ruptures and those with incomplete, complete, or complete combined pulley ruptures (P <.001). The sensitivity of US for depiction of finger pulley injuries was 98%, and specificity was 100%. 3
67. Martinoli C, Bianchi S, Cotten A. Imaging of rock climbing injuries. Semin Musculoskelet Radiol. 2005;9(4):334-345. Review/Other-Dx N/A To summarize the current literature regarding the application of imaging modalities in the diagnosis of rock climbing injuries with a specific focus on ultrasound and magnetic resonance imaging. No results stated in abstract. 4
68. Connell DA, Pike J, Koulouris G, van Wettering N, Hoy G. MR imaging of thumb carpometacarpal joint ligament injuries. J Hand Surg Br. 2004;29(1):46-54. Review/Other-Dx 14 patients To describe the MR imaging appearances of the supporting ligaments of the thumb carpometacarpal joint in asymptomatic volunteers and in a group of patients following joint injury. The anterior oblique ligament was the most commonly injured ligament, usually on the metacarpal side where it was disrupted, or allowed dislocation because of subperiosted stripping from the base of the thumb metacarpal. The dorsal radial ligament was occasionally avulsed or partially torn from the trapezoid. 4
69. Rubin DA, Kneeland JB, Kitay GS, Naranja RJ, Jr. Flexor tendon tears in the hand: use of MR imaging to diagnose degree of injury in a cadaver model. AJR Am J Roentgenol. 1996;166(3):615-620. Observational-Dx 4 hand-and-forearm from cadavers To investigate the potential of MR imaging in evaluating these injuries. Twelve high-grade flexor tendon tears (10 complete tears, with 1- to 14-mm separation of the torn ends, and two partial tears involving 50% or more of the total tendon cross-sectional area) and two partial tears of less than 50% of tendon area were produced; four tendons were not injured. Using MR imaging, we diagnosed 11 of the 12 high-grade lesions (those involving at least 50% of the total tendon cross-sectional area); the MR images did not show one complete tear whose separation measured 2 mm long at dissection. All intact tendons were correctly identified. We underestimated the extent of five lesions but overestimated none. Using the reformatted images, we reduced the number of errors that we would have made interpreting the transverse images alone. 4
70. Hauger O, Chung CB, Lektrakul N, et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology. 2000;217(1):201-212. Observational-Dx 8 cadaveric hands To describe the normal anatomy of the finger flexor tendon pulley system, with anatomic correlation, and to define criteria to diagnose pulley abnormalities with different imaging modalities. MR imaging demonstrated A2 (proximal phalanx) and A4 (middle phalanx) pulleys in 12 (100%) of 12 cases, without and with tenography. MR tenography showed the A3 (proximal interphalangeal) and A5 (distal interphalangeal) pulleys in 10 (83%) and nine (75%) cases, respectively. US showed the A2 pulley in all cases and the A4 pulley in eight (67%). CT did not allow direct pulley visualization. No significant differences in pulley lengths were measured at MR, US, or pathologic examination (P: =.512). Direct lesion diagnosis was possible with MR imaging and US in 79%-100% of cases, depending on lesion type. Indirect diagnosis was successful with all methods with forced flexion. 3
71. Clavero JA, Alomar X, Monill JM, et al. MR imaging of ligament and tendon injuries of the fingers. [Review] [50 refs]. Radiographics. 22(2):237-56, 2002 Mar-Apr. Review/Other-Dx N/A To review the normal anatomy of the finger together with the clinical and MR imaging findings of the most frequent soft-tissue injuries, which are divided into articular and tendon injuries. No results stated in abstract. 4
72. Prucz RB, Friedrich JB. Finger joint injuries. Clin Sports Med. 2015;34(1):99-116. Review/Other-Dx N/A To discuss the treatment of sprains, dislocations, and fracturedislocations of the metacarpophalangeal and IP joints in this unique patient population. No results stated in abstract. 4
73. Drape JL, Dubert T, Silbermann O, Thelen P, Thivet A, Benacerraf R. Acute trauma of the extensor hood of the metacarpophalangeal joint: MR imaging evaluation. Radiology. 1994;192(2):469-476. Observational-Dx 54 normal MP joints To assess detectability of the components of the extensor hood, especially the sagittal bands, with magnetic resonance (MR) imaging in normal and injured metacarpophalangeal (MP) joints. The sensitivity of MR imaging for the detection of normal sagittal bands was 0.89-0.92 for T2*-weighted images, 0.80-0.88 for T1-weighted images, and 0.81-0.91 for contrast-enhanced T1-weighted images. MR imaging findings in patients with extensor hood injury included irregularity, poor definition, and increased signal intensity or uptake of contrast material by structures in and around the extensor hood. All MR imaging findings correlated well with those of surgery. 3
74. Pfirrmann CW, Theumann NH, Botte MJ, Drape JL, Trudell DJ, Resnick D. MR imaging of the metacarpophalangeal joints of the fingers: part II. Detection of simulated injuries in cadavers. Radiology. 222(2):447-52, 2002 Feb. Observational-Dx 28 fingers of seven human cadaveric hands. To evaluate and compare conventional magnetic resonance (MR) imaging and MR arthrography in the diagnosis of the most common traumatic metacarpophalangeal (MCP) joint injuries, which were created surgically in cadavers. Sensitivity was 28.6%-93.8% with conventional MR imaging versus 50.0%-93.3% with MR arthrography. Specificity was 66.7%-100% with conventional MR imaging versus 83.3%-100% with MR arthrography. Although the MR arthrographic results usually were higher, the differences were not significant. The kappa values for interobserver agreement were 0.314-0.638 for conventional MR imaging versus 0.364-1.00 for MR arthrography. Sensitivity for the detection of lesions of the main and accessory CLs and the first annular pulley was slightly higher than that for the detection of lesions of the extensor hood, DTML, and palmar plate structures. 3
75. Lopez-Ben R, Lee DH, Nicolodi DJ. Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US--report of three cases. Radiology. 2003;228(3):642-646. Review/Other-Dx 3 patients To provide an initial assessment of the usefulness of dynamic US and magnetic resonance (MR) imaging in the diagnosis of sagittal band rupture in two surgically confirmed cases and in an asymptomatic volunteer with the congenital ability to dislocate the common extensor tendons. No results stated in abstract. 4
76. Lee DH, Robbin ML, Galliott R, Graveman VA. Ultrasound evaluation of flexor tendon lacerations. J Hand Surg Am. 2000;25(2):236-241. Observational-Dx 10 patients To prospectively determine whether flexor tendon ultrasonography could accurately evaluate the status of a potentially lacerated or lacerated flexor tendon. Ultrasonography accurately identified the status of the flexor tendon in 11 of 13 digits and in 18 of 20 flexor tendons (12 intact, 2 partial lacerations, and 6 complete tendon lacerations). With complete tendon lacerations the location of the proximal tendon stump was accurately identified in 5 of 6 digits. There were 2 false ultrasound findings, including incorrectly identifying a 75% laceration in an intact index flexor and a complete tendon laceration in a 75% lacerated index finger flexor. 2
77. Jarraya M, Hayashi D, de Villiers RV, et al. Multimodality imaging of foreign bodies of the musculoskeletal system. [Review]. AJR Am J Roentgenol. 203(1):W92-102, 2014 Jul. Review/Other-Dx N/A To clarify the most relevant points in managing suspected foreign bodies of the musculoskeletal system on the basis of a literature review and published reports with cases to illustrate each type on different imaging modalities. Foreign bodies of the musculoskeletal system are a common problem in emergency departments, with more than a third missed in the initial clinical evaluation. These retained objects may result in various complications and also offer fertile ground for litigation. 4
78. Panigrahi R, Dash SK, Palo N, Priyadarshi A, Sahu SK, Biswal MR. Foreign Body Detection in Musculoskeletal Injuries: A In Vitro Blinded Study Comparing sensitivity among Digital radiography, Ultrasonography, CT and Magnetic Resonance Imaging. Musculoskeletal Regeneration 2015;1:e649. Experimental-Dx Four goat thighs To compare Digital radiography, CT, MRI and Hi-Frequency ultrasound with respect to suitability for detecting foreign bodies in In-vitro (goat thigh specimens) and to formulate a foreign body detection protocol which is universal and practical to use especially for setups in country like ours. Conventional radiography is preferred imaging method for radiopaque foreign bodies, which were visualized with all 4 modalities. USG is a useful tool for superficial and deep (within 3 cms) low radiopaque foreign bodies (Wood, sand, fiber plastic). CT is a standard method for imaging and localizing deep foreign bodies because their shape and size are accurately reproduced. MRI has high intra-observer variations, is an expensive tool which might not be available at all the centers and time. Radiography as a primary tool teamed up by Ultrasonography can detect almost all routine foreign bodies. CT/MRI may follow if intervention is planned or information regarding size, orientation and location is desired based on availability. Successful detection requires detailed patient’s information and suspected nature of foreign body or accident site. 1
79. Valizadeh S, Pouraliakbar H, Kiani L, Safi Y, Alibakhshi L. Evaluation of Visibility of Foreign Bodies in the Maxillofacial Region: Comparison of Computed Tomography, Cone Beam Computed Tomography, Ultrasound and Magnetic Resonance Imaging. Iran J Radiol. 2016;13(4):e37265. Experimental-Dx sheep’s head implanted with fabricated foreign bodies (six materials) To compare four commonly used imaging modalities namely cone beam computed tomography (CBCT), magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) for detection of FBs in the head and neck region. All FBs in the tongue and at the soft tissue-bone interface had good visibility on US (P = 1.00). Also, CBCT and CT had significantly different performance regarding FB detection (P < 0.001). All wooden samples in the nasal cavity were invisible on CT scans; while, only 20% of them were invisible on CBCT scans. MRI showed significant differences for detection of FBs in the three locations (P < 0.001). MRI could not locate iron samples due to severe artifacts and only showed their presence (bad visibility) but other FBs except for wood and tooth in the nasal cavity (100% invisible) had good visibility on MRI. 3
80. Pattamapaspong N, Srisuwan T, Sivasomboon C, et al. Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot. Radiol Med (Torino). 118(2):303-10, 2013 Mar. Experimental-Dx 160 FBs (cadaver feet) To determine the accuracy of conventional radiography, CT and MRI in detecting FBs by using cadaver feet. Overall sensitivity and specificity for FB detection was 29% and 100% for radiographs, 63% and 98% for CT and 58% and 100% for MRI. The sensitivity of radiography was lower in the forefoot. CT and MRI detection rates depended on the attenuation values of the FBs and on the susceptibility artifact, respectively. CT was superior to MRI in identifying water-rich fresh wood. 2
81. Expert Panel on Musculoskeletal Imaging:, Beaman FD, von Herrmann PF, et al. ACR Appropriateness Criteria R Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). [Review]. J. Am. Coll. Radiol.. 14(5S):S326-S337, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). No results stated in abstract. 4
82. Bao H, Wang S, Wang G, et al. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm. Eur Radiol. 27(6):2359-2366, 2017 Jun. Observational-Dx 32 volunteers and 21 patients To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 +/- 0.46 and 3.23 +/- 0.67 for observer 1, and 3.70 +/- 0.46 and 3.22 +/- 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 +/- 0.62 and 3.10 +/- 0.83, inter-observer performance was excellent (k = 0.842). 2
83. Aras MH, Miloglu O, Barutcugil C, Kantarci M, Ozcan E, Harorli A. Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography. Dentomaxillofac Radiol. 2010;39(2):72-78. Experimental-Dx Seven different materials into a sheep's head between the corpus mandible and muscle, in the tongue and in the maxillary sinus. To compare the sensitivity for detecting foreign bodies among conventional plain radiography, CT and ultrasonography in in vitro models. Metal, glass and stone can be detected with all the visualization techniques used in the study in all of the zones. In contrast to this, foreign bodies with low radiopacity, which could be detected in air with CT, became less visible or almost invisible in muscle tissue and between bone and muscle tissue. The performance of ultrasonography for visualizing foreign bodies with low radiopacity is relatively better than CT. 2
84. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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