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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Kransdorf MJ, Murphey MD, Wessell DE, et al. ACR Appropriateness Criteria® Soft-Tissue Masses. J Am Coll Radiol 2018;15:S189-S97. 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 soft-tissue masses. No results stated in abstract. 4
2. Subhas N, Wu F, Fox MG, et al. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023;20:S20-S32. 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 chronic extremity joint pain-suspected inflammatory arthritis, crystalline arthritis, or erosive osteoarthritis. No results stated in abstract. 4
3. Pierce JL, Perry MT, Wessell DE, et al. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022;19:S473-S87. 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
4. Ha AS, Chang EY, Bartolotta RJ, et al. ACR Appropriateness Criteria R Osteonecrosis: 2022 Update. Journal of the American College of Radiology. 19(11S):S409-S416, 2022 11. 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 osteonecrosis. No results stated in abstract. 4
5. Bencardino JT, Stone TJ, Roberts CC, et al. ACR Appropriateness Criteria® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae. J Am Coll Radiol 2017;14:S293-S306. 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 stress (fatigue/insufficiency) fracture, including sacrum, excluding other vertebrae. No results stated in abstract. 4
6. DaSilva MF, Goodman AD, Gil JA, Akelman E. Evaluation of Ulnar-sided Wrist Pain. [Review]. J Am Acad Orthop Surg. 25(8):e150-e156, 2017 Aug. Review/Other-Dx N/A To review the role of diagnostic imaging in the evaluation of ulnar-sided wrist pain. No results stated in abstract. 4
7. Daun M, Rudd A, Cheng K, Rezai F. Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex. [Review]. Top Magn Reson Imaging. 29(5):237-244, 2020 Oct. Review/Other-Dx N/A To provide a detailed understanding of the normal anatomy of the TFCC, imaging limitations and pitfalls, the Palmer classification system, and current treatment options is critical to the accurate and clinically useful interpretation of radiologic examinations of the TFCC. No results stated in abstract. 4
8. Faucher GK, Moody MC. LT Ligament Tears. [Review]. Hand Clin. 37(4):537-543, 2021 11. Review/Other-Dx N/A To discuss anatomy, pathophysiology, and treatment options of lunotriquetral ligament injuries. No results stated in abstract. 4
9. Gulati A, Wadhwa V, Ashikyan O, Cerezal L, Chhabra A. Current perspectives in conventional and advanced imaging of the distal radioulnar joint dysfunction: review for the musculoskeletal radiologist. [Review]. Skeletal Radiol. 48(3):331-348, 2019 Mar. Review/Other-Dx N/A To discuss the normal anatomy and biomechanics of the DRUJ, illustrate common clinical abnormalities, and provide a comprehensive overview of the imaging evaluation with an insight into the role of advanced cross-sectional modalities in this domain. No results stated in abstract. 4
10. Jens S, Luijkx T, Smithuis FF, Maas M. Diagnostic modalities for distal radioulnar joint. [Review]. J. hand surg., Eur. vol.. 42(4):395-404, 2017 May. Review/Other-Dx N/A To discuss the most useful imaging techniques in terms of clinical indications, patient positioning, technical imaging requirements, and diagnostic performance in patients with suspected distal radioulnar joint pathology. No results stated in abstract. 4
11. 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
12. Zanetti M, Saupe N, Nagy L. Role of MR imaging in chronic wrist pain. Eur Radiol. 2007;17(4):927-938. Review/Other-Dx N/A To review potential and limitations of MRI and direct and indirect MR arthrography in chronic wrist pain. MRI correlates well with surgery for internal derangement of the wrist (excellent accuracy) with consistently better results for SL vs LT ligaments, and more variable results depending on TFCC tear location (central vs partial); enhanced MRI best for avascularity and other marrow abnormalities; MRI vs CT for detection of occult fractures remains controversial and of questionable clinical import. 4
13. Tiegs-Heiden CA, Howe BM. Imaging of the Hand and Wrist. [Review]. Clin Sports Med. 39(2):223-245, 2020 Apr. Review/Other-Dx N/A To review the strengths and limitations of these imaging modalities and how they can be utilized in commonly encountered clinical questions. No results stated in abstract. 4
14. McAlindon T, Kissin E, Nazarian L, et al. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken). 2012;64(11):1625-1640. Review/Other-Dx N/A A report by American College of Rheumatology on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. N/A 4
15. Schoffl I, Hugel A, Schoffl V, Rascher W, Jungert J. Diagnosis of Complex Pulley Ruptures Using Ultrasound in Cadaver Models. Ultrasound Med Biol. 43(3):662-669, 2017 03. Observational-Dx 34 cadaver fingers from 10 body donors To determine the specific positioning of each pulley with regards to the joint, and to evaluate the ultrasound diagnostics of various pulley rupture combinations. Visualization of the A2 and A4 pulleys was achieved 100% of the time, while the A3 pulley was visible in 74% of cases. Similarly, injuries to the A2 and A4 pulleys were readily observable, while A3 pulley injuries were more challenging to identify (sensitivity of 0.2 for singular A3 pulley, 0.5 for A2/A4 pulley and 0.33 for A3/A4 pulley ruptures). Receiver operating characteristic analysis was used to evaluate the optimal tendon-bone distance for pulley rupture diagnosis, a threshold which was determined to be 1.9 mm for A2 pulley ruptures and 1.85 for A4 pulley ruptures. 3
16. Fjellstad CM, Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Associations Between Ultrasound-Detected Synovitis, Pain, and Function in Interphalangeal and Thumb Base Osteoarthritis: Data From the Nor-Hand Cohort. Arthritis Care Res (Hoboken). 72(11):1530-1535, 2020 11. Observational-Dx 290 patients with hand OA To explore whether ultrasound-detected gray-scale synovitis and power Doppler activity in the interphalangeal and first carpometacarpal (CMC1) joints are associated with pain and physical function in patients with hand osteoarthritis (OA). At joint level, increasing gray-scale synovitis severity was associated with higher odds of pain upon palpation in both the interphalangeal (grade 2-3; odds ratio [OR] 3.17 [95% confidence interval (95% CI) 2.35, 4.28]) and CMC1 joints (grade 2-3; OR 4.40 [95% CI 2.10, 9.24]). Similar associations were found for power Doppler activity and joint pain in the previous 24 hours and 6 weeks. 2
17. Tagliafico A, Bignotti B, Rossi F, Rubino M, Civani A, Martinoli C. Clinical Contribution of Wrist and Hand Sonography: Pilot Study. J Ultrasound Med. 38(1):141-148, 2019 Jan. Review/Other-Dx 126 examinations To evaluate the clinical contribution of wrist and hand sonography. In 96 of 126 (76%) examinations, sonography proved to be contributive, and in 30 of 126 (24%) examinations, sonography proved to be noncontributive. The contributive/noncontributive ratio was 3.2 (96/30). A total of 51 of 126 (40%) examinations were performed in patients with a history of previous trauma. Sonography proved to be significantly more contributive in a posttraumatic setting (chi-square, 9.2; P = .0023). 4
18. Dietrich TJ, Toms AP, Cerezal L, et al. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol. 31(12):9446-9458, 2021 Dec. Review/Other-Dx N/A To establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. 4
19. Al-Janabi M. Imaging modalities of the painful wrist: the role of bone scintigraphy. Rheumatology (Oxford). 2002;41(10):1085-1087. Review/Other-Dx N/A Editorial on the role of bone scintigraphy of the painful wrist. No results stated in abstract. 4
20. Yin ZG, Zhang JB, Kan SL, Wang XG. Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis. Clin Orthop Relat Res. 2010;468(3):723-734. Meta-analysis 26 studies To assess and compare the diagnostic performance of bone scintigraphy, MRI, and CT for diagnosing suspected scaphoid fractures. The pooled sensitivity, specificity, natural logarithm of the diagnostic odds ratio, and the positive and negative likelihood ratios were, respectively, 97%, 89%, 4.78, 8.82, and 0.03 for bone scintigraphy; 96%, 99%, 6.60, 96, and 0.04 for MRI; and 93%, 99%, 6.11, 93, and 0.07 for CT. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. M
21. 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
22. De Filippo M, Pogliacomi F, Bertellini A, et al. MDCT arthrography of the wrist: diagnostic accuracy and indications. Eur J Radiol. 2010;74(1):221-225. Observational-Dx 44 wrists To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k=0.96) and statistically significant (p<0.05). Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients. 3
23. Schmid MR, Schertler T, Pfirrmann CW, et al. Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology. 2005;237(3):1008-1013. Observational-Dx 8 patients; 9 cadavers Comparison of CT arthrography (3 compartment injection) vs unenhanced MRI for intrinsic ligament tears (three segments of SL and LT ligaments) in cadavers, with subsequent direct anatomic correlation. CT arthrography is superior to (more sensitive than) MRI for dorsal segment tears, with more equivalent performance for palmar and central tears; for all segments of both ligaments, interobserver agreement is much better for CT arthrography than MRI. 2
24. Szabo RM. Distal radioulnar joint instability. J Bone Joint Surg Am. 2006;88(4):884-894. Review/Other-Dx N/A To review the anatomy, classification, and examination of radioulnar joint instability. No results stated in abstract. 4
25. Wijffels M, Stomp W, Krijnen P, Reijnierse M, Schipper I. Computed tomography for the detection of distal radioulnar joint instability: normal variation and reliability of four CT scoring systems in 46 patients. Skeletal Radiol. 45(11):1487-93, 2016 Nov. Observational-Dx 46 participants with 92 wrist To evaluate inter- and intraobserver agreement and normal ranges of CT scoring methods for determination of DRUJ translation in both posttraumatic and uninjured wrists. Interobserver agreement was best for the epicenter method [ICC?=?0.73, 95 % confidence interval (CI) 0.65–0.79]. Intraobserver agreement was almost perfect for the radioulnar line method (ICC?=?0.82, 95 % CI 0.77–0.87). Each method showed a wide normal range for normal DRUJ translation. Normal range for the epicenter method is -0.35 to -0.06 in pronation and -0.11 to 0.19 in supination. 2
26. Carr LW, Adams B. Chronic Distal Radioulnar Joint Instability. [Review]. Hand Clin. 36(4):443-453, 2020 11. Review/Other-Dx N/A To provide a comprehensive understanding DRUJ instability of the bony and soft tissue anatomy. No results stated in abstract. 4
27. Ten Berg PW, Dobbe JG, Horbach SE, Gerards RM, Strackee SD, Streekstra GJ. Analysis of deformity in scaphoid non-unions using two- and three-dimensional imaging. J. hand surg., Eur. vol.. 41(7):719-26, 2016 Sep. Observational-Dx 28 patients To provide better insights into the deformity of scaphoid non-union using 3D CT and to relate these quantitative values with conventional measurements and clinical parameters. Three-dimensional flexion deformity (mean 26°) did not correlate with intrascaphoid and capitatelunate angles. Osteophyte volume was positively correlated with bone loss and stage of scaphoid non-union advanced collapse. Osteophyte volume and bone loss increased over time. 3
28. Schweizer A, Mauler F, Vlachopoulos L, Nagy L, Furnstahl P. Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy. J Hand Surg [Am]. 41(1):59-69, 2016 Jan. Observational-Dx 22 men To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides. In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). 3
29. Asaad AM, Andronic A, Newby MP, Harrison JWK. Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain. J. hand surg., Eur. vol.. 42(6):580-585, 2017 Jul. Observational-Dx 50 patients To determine the the overall accuracy of magnetic resonance arthrography in detecting full-thickness triangular fibrocartilage complex tears, intrinsic carpal ligamentous lesions, wrist synovitis and chondral lesions in the radiocarpal joint. The sensitivities of magnetic resonance arthrography in detecting central triangular fibrocartilage complex tears, peripheral triangular fibrocartilage complex tears, scapholunate ligament tears, lunotriquetral ligament tears, dorsal synovitis and radiocarpal chondral lesions were 89%, 63%, 71%, 100%, 32% and 65%, respectively, and its specificities in detecting these lesions were 91%, 98%, 89%, 94% 94% and 97%, respectively. 3
30. 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
31. Lee RK, Ng AW, Tong CS, et al. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol 2013;42:1277-85. Observational-Dx 5 cadavers; 10 wrists To compare the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist. Intravenous contrast was administered. Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100%/100%/100%, 66%/86%/80%, 100%/86%/90% for the detection of SLL tear, 100%/80%/90%, 60%/80%/70%, 100%/80%/90% for the detection of LTL tear, and 100%/100%/100%, 100%/86%/90%, 100%/100%/100% for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities. 3
32. Hafezi-Nejad N, Carrino JA, Eng J, et al. Scapholunate Interosseous Ligament Tears: Diagnostic Performance of 1.5 T, 3 T MRI, and MR Arthrography-A Systematic Review and Meta-analysis. [Review]. Acad Radiol. 23(9):1091-103, 2016 09. Meta-analysis 103 conference proceedings, 24 studies To perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury. Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P < 0.001) but not for 3.0 T MRI (chi-square: 8.00, P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1-51.4), 75.7% (66.8-83.2), and 82.1% (76.1-87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3-83.4), 97.1% (89.8-99.6), and 92.8% (90.2-94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71-11.39), 23.23 (3.16-171.00), and 65.04 (32.89-128.62) (P value < 0.001), respectively. The results were consistent after addressing publication bias and sensitivity analyses. Good
33. Petsatodis E, Pilavaki M, Kalogera A, Drevelegas A, Agathangelidis F, Ditsios K. Comparison between conventional MRI and MR arthrography in the diagnosis of triangular fibrocartilage tears and correlation with arthroscopic findings. Injury. 50(8):1464-1469, 2019 Aug. Observational-Dx 60 patients To compare the diagnostic accuracy between conventional MRI and MR arthrography (MRA) in the depiction of triangular fibrocartilage complex (TFCC) tears. 40 tears were confirmed by arthroscopy. 38/40 tears were identified by MRA while MRI identified 26/40 tears. There were also 8 false positives and 13 false negative results identified by MRI. Two false negative results were identified by MRA. No false positive results were identified. 3
34. Lee RK, Griffith JF, Ng AW, Nung RC, Yeung DK. Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage. AJR Am J Roentgenol. 206(1):155-61, 2016 Jan. Observational-Dx 40 wrists in 39 patients To assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments. With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p = 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears. 2
35. Anderson SE, Steinbach LS, Stauffer E, Voegelin E. MRI for differentiating ganglion and synovitis in the chronic painful wrist. AJR Am J Roentgenol 2006;186:812-8. Observational-Dx 34 patients; 2 blinded observers Retrospective study to determine if preoperative IV-contrast-enhanced MRI can distinguish between ganglion (including occult dorsal ganglia) and synovitis in chronic wrist pain. MRI accurate in preoperative differentiation of ganglion vs synovitis in chronic dorsal wrist pain; four main radiographs criteria useful—margin, shape, internal structure, and enhancement, with shape and internal structure most helpful. For ganglia, MR sensitivity = 89-94%; specificity = 85-95%. 3
36. 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
37. Ochman S, Wieskotter B, Langer M, Vieth V, Raschke MJ, Stehling C. High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary?. Arch Orthop Trauma Surg. 137(10):1443-1450, 2017 Oct. Observational-Dx 18 patients To assess the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard. The classifications of the cartilage lesions showed good correlations with the arthroscopy findings (? = 0.8-0.9). In contrast to the arthroscopy, cartilage of the distal carpal row was very good and could be evaluated in all patients on MRI. The sensitivity for the TFCC lesion was 83%, and the specificity was 42% (radiologist 1) and 63% (radiologist 2). For the ligament lesions, the sensitivity and specificity were 75 and 100%, respectively, with a high interobserver agreement (? = 0.8-0.9). 3
38. Boer BC, Vestering M, van Raak SM, van Kooten EO, Huis In 't Veld R, Vochteloo AJH. MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist. Eur. j. orthop. surg. traumatol.. 28(8):1549-1553, 2018 Dec. Observational-Dx 150 patients To determine whether MRA is superior to MRI and whether 3.0 T is better than 1.5 T (expresses in sensitivity, specificity and accuracy) in detecting TFCC injury, using arthroscopy as the gold standard. MRA was slightly more accurate compared to conventional MRI, and 1.5 T was slightly more accurate than 3.0 T. 1.5 T wrist MRA had a sensitivity of 80%, a specificity of 100% and accuracy of 90%; 3.0 T wrist MRA 73, 100 and 86%, resp. Conventional 1.5 T wrist MRI had a sensitivity of 71%, a specificity of 75% and accuracy of 73%. For 3.0 T conventional MRI, this was 73, 67 and 70%, resp. 3
39. Zhan H, Bai R, Qian Z, Yang Y, Zhang H, Yin Y. Traumatic injury of the triangular fibrocartilage complex (TFCC)-a refinement to the Palmer classification by using high-resolution 3-T MRI. Skeletal Radiol. 49(10):1567-1579, 2020 Oct. Observational-Dx 67 patients To investigate the MR features of the traumatic injury of the triangular fibrocartilage complex (TFCC) by using high-resolution 3-T magnetic resonance imaging (MRI) and to refine the Palmer classification system. There were 49 cases of TFCC injuries proven by the arthroscopy or surgery. The TFCC injuries in the other 18 patients were proved by the combination of clinical follow-up examination and follow-up MRI. Among the arthroscopy- or surgery-confirmed cases, there were 32 patients with original Palmer injuries (IA = 10, IB = 19, ID = 3), 5 with capsular detachment, 4 with bucket-handle tear of the TFCC that have rarely been reported, and 8 with complex injuries that involved the listed classifications above. The sensitivities and specificities of MRI for diagnosing IA, IB, ID, complex injuries, and bucket-handle tear were 67-100% and 90-100%, and overall good to perfect interobserver agreements (kappa, 0.64-1.00). The diagnostic performance for the capsular detachment was lower (kappa, 0.38). 3
40. Eladawi S, Balamoody S, Amerasekera S, Choudhary S. 3T MRI of wrist ligaments and TFCC using true plane oblique 3D T2 Dual Echo Steady State (DESS) - a study of diagnostic accuracy. Br J Radiol. 95(1129):20210019, 2022 Jan 01. Observational-Dx 46 patients To assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. 3
41. Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR Jr. The Traumatized TFCC: An Illustrated Review of the Anatomy and Injury Patterns of the Triangular Fibrocartilage Complex. [Review]. Curr Probl Diagn Radiol. 45(1):39-50, 2016 Jan-Feb. Review/Other-Dx N/A To provide a detailed overview of TFCC anatomy, its normal appearance on magnetic resonance imaging, the spectrum of TFCC injuries based on the Palmer classification system, and pitfalls in accurate assessment. No results stated in abstract. 4
42. Parellada AJ, Gopez AG, Morrison WB, et al. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol. 2007;36(3):203-208. Review/Other-Dx 5 patients Presents MRI findings of extensor tenosynovitis at distal intersection of 2nd/3rd compartment tendons, and anatomic details involved in pathogenesis of condition. All patients had signs of tenosynovitis; tendinosis follows tenosynovitis; one patient had reactive edema at Lister’s tubercle. 4
43. 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
44. Ratasvuori MS, Lindfors NC, Sormaala MJ. The clinical significance of magnetic resonance imaging of the hand: an analysis of 318 hand and wrist images referred by hand surgeons. J Plast Surg Hand Surg. 56(2):69-73, 2022 Apr. Review/Other-Dx 318 consecutive images from 316 patients To describe an outcome analysis of the utility of MRI in a cohort of patients treated in our hand surgery clinic. Ganglions (28%), findings on the extensor carpi ulnaris tendon (18%) and on the triangular fibrocartilage (18%) were the most common findings and increased with patient age; the clinical significance of these findings was minimal. The correlation between the clinical scaphoid shift test or the fovea sign test and MRI was also non-significant. Despite findings on MRI, the diagnosis remained unsolved in 76 (24%) cases. However, MRI had a role in reassuring the patient, and in 70% of the cases, further follow-up was unnecessary. 4
45. Smith TO, Drew BT, Toms AP, Chojnowski AJ. The diagnostic accuracy of X-ray arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. J Hand Surg Eur Vol 2012;37:879-87. Meta-analysis 12 studies, 430 patients To evaluate the diagnostic test accuracy of X-ray arthrography in the detection of TFCC tear. X-ray arthrography presented with a pooled sensitivity of 76.2% and specificity of 92.5% for the detection of complete TFCC tear. The triple-compartment injection X-ray arthrography was superior to the single-compartment injection technique. M
46. Kichouh M, De Maeseneer M, Jager T, et al. Ultrasound findings in injuries of dorsal extensor hood: correlation with MR and follow-up findings. Eur J Radiol. 77(2):249-53, 2011 Feb. Review/Other-Dx 9 patients To use ultrasound to examine the dorsal hood in nine patients with a clinical suspicion of dorsal hood injuries. The sagittal bands were easily depicted in the transverse plane on ultrasound images and presented as hypoechoic bands on both sides of the extensor communis tendons. Injuries of the sagittal bands were seen on ultrasound as hypoechoic thickening of the sagittal bands at the side of the extensor tendons. The normal shape of the sagittal bands was also no longer recognizable. Subluxations or dislocations of the extensor tendons were also seen. When the injuries were located in the fibrous slips between the extensor indicis and the extensor communis of the second finger, subluxations with an increased distance between these 2 tendons were seen, especially in flexion, or in flexion with resistance. 4
47. Liu R, Damman W, Reijnierse M, Bloem JL, Rosendaal FR, Kloppenburg M. Bone marrow lesions on magnetic resonance imaging in hand osteoarthritis are associated with pain and interact with synovitis. Osteoarthritis Cartilage. 25(7):1093-1099, 2017 07. Review/Other-Dx 105 consecutive primary hand OA patients To determine the association between bone marrow lesions (BMLs) and (teno)synovitis as assessed on magnetic resonance (MR) imaging in patients with pain in hand osteoarthritis (OA). BMLs, synovitis, cysts, FTS and ETI were demonstrated in 56%, 90%, 22%, 16% and 30% of patients, respectively. BMLs (grade 2/3 vs 0: 3.5 (1.6-7.7)) and synovitis (3 vs 0: OR 3.6 (95% CI 1.9-6.6)) were severity-dependent associated with joint pain, but FTS and ETI were not. 4
48. van Beest S, Damman W, Liu R, Reijnierse M, Rosendaal FR, Kloppenburg M. In finger osteoarthritis, change in synovitis is associated with change in pain on a joint-level; a longitudinal magnetic resonance imaging study. Osteoarthritis Cartilage. 27(7):1048-1056, 2019 07. Review/Other-Dx 85 patients To investigate determinants of decrease and increase in joint pain in symptomatic finger osteoarthritis (OA) on magnetic resonance (MR) imaging over 2 years. Of 116 painful joints at baseline, at follow-up: 76 had less pain, 21 less synovitis, and 13 less BMLs. A decrease in synovitis (OR = 5.9; 1.12-31.0), but not in BMLs (OR = 0.39; 0.10-1.50), was associated with less pain. Of 678 joints without maximum baseline pain, at follow-up: 115 had increased pain, 132 increased synovitis, 96 increased BMLs, and 44 increased osteophytes. Increased synovitis (OR = 1.81; 1.11-2.94), osteophytes (OR = 2.75; 1.59-4.8), but not BMLs (OR = 1.14; 0.81-1.60), was associated with increased pain. 4
49. Ramonda R, Favero M, Vio S, et al. A recently developed MRI scoring system for hand osteoarthritis: its application in a clinical setting. Clin Rheumatol. 35(8):2079-2086, 2016 Aug. Observational-Dx 11 female patients To apply the recently proposed Oslo hand osteoarthritis magnetic resonance imaging (MRI) scoring system to evaluate MRI findings in a cohort of patients affected by long-standing erosive hand osteoarthritis (EHOA). Spearman's non-parametric test was used to analyze the correlations between variables. MRI intra- and inter-reader reliability were found between good and moderate for many features. No statistical differences were found between the radiographs and MRI with regard to detection of JSN, malalignment, and bone erosions. Synovitis was detected in 39.8 % of the 80 joints examined (in a mild form in 80 %), erosions were found in 51.1 %, and BMLs were identified in 20.5 and 23.9 % at the distal and the proximal side, respectively. BMLs at both the proximal and distal ends were correlated with tender joints (BML distal p = 0.0013, BML proximal p = 0.012). The presence of synovitis was correlated with tenderness (p = 0.004) and erosions at both the distal and proximal joints (p = 0.004). The presence of erosions correlated with tender joints (p < 0.01) and the mean visual analog scale (VAS) score (distal p = 0.03, proximal p = 0.01). 3
50. 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
51. Theumann NH, Pessis E, Lecompte M, et al. MR imaging of the metacarpophalangeal joints of the fingers: evaluation of 38 patients with chronic joint disability. Skeletal Radiol. 34(4):210-6, 2005 Apr. Review/Other-Dx 39 injured MCP joints in 38 patients To report the MR imaging findings of painful injured metacarpophalangeal (MCP) joints of the fingers. Tears of the collateral ligaments were the most common lesion (30/39), most being radial in location. Contrast-enhanced axial T1-weighted images with the MCP joint in a flexed position showed these lesions optimally. Ten tears were partial and 20 were complete. In 13 patients, MR images showed 17 associated lesions including injuries of the extensor hood (10/17), interosseous tendon (3/17), palmar plate (3/17), and an osteochondral lesion (1/17). 4
52. Nevalainen MT, Roedl JB, Morrison WB, Zoga AC. MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries. Skeletal Radiol. 48(7):1079-1085, 2019 Jul. Review/Other-Dx 68 patients To report patterns of MRI findings involving carpal boss and extensor carpi radialis brevis (ECRB) tendon insertion in individuals with overuse-related or post-traumatic wrist pain. Fused carpal bossing was detected in 21%, partial coalition in 35%, and os styloideum in 44% of the cases. Regional BME was observed in 64% of the cases. When BME specifically at the carpal boss was assessed, 78% of stable and 50% of unstable bosses showed BME (p = 0.035). ECRB tendon inserted on a carpal boss in 20%, on the 3rd metacarpal bone in 35%, and on both sites in 45% of the cases. As BME at the carpal boss was assessed, BME was detected at the respective insertion sites in 71%, 35%, and 66% of the cases (p = 0.015). Dorsal wrist pain was associated with BME as 75% of the patients had regional BME in the vicinity of the carpal boss (p = 0.006). 4
53. van Beest S, Kroon HM, Reijnierse M, Rosendaal FR, Kloppenburg M, Kroon FPB. Two-Year Changes in Magnetic Resonance Imaging Features and Pain in Thumb Base Osteoarthritis. Arthritis Care Res (Hoboken). 73(11):1628-1637, 2021 11. Review/Other-Dx 165 patients To investigate the two-year course of pain and osteoarthritic features on magnetic resonance imaging (MRI) in the thumb base. At baseline, 65 patients had thumb base pain. At 2-year follow-up, pain had decreased in 32 patients and increased in 33 patients. MRI features remained stable in most patients. Structural MRI features generally deteriorated, while synovitis and BMLs improved in some individuals and deteriorated in others. Change in radiographic osteophytes rarely occurred (n = 10). Increased synovitis (odds ratio [OR] 3.4 [95% CI 1.3-9.3]) and increased BMLs (OR 5.1 [95% CI 2.1-12.6]) were associated with increased pain. Decreased BMLs appeared to be associated with decreased pain (OR 2.7 [95% CI 0.8-8.9]), and reductions in synovitis occurred too infrequently to calculate associations. 4
54. Shin YE, Kim SJ, Kim JS, Kwak KY, Kim JH, Kim JP. Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy. J. ORTHOP. SURG.. 28(3):2309499020978308, 2020 Sep-Dec. Observational-Dx 56 consecutive patients (56 thumbs) To assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). 2
55. Pianta M, McCombe D, Slavin J, Hendry S, Perera W. Dual-energy contrast-enhanced CT to evaluate scaphoid osteonecrosis with surgical correlation. J Med Imaging Radiat Oncol. 63(1):69-75, 2019 Feb. Observational-Dx 19 patients To evaluate the validity of contrast enhanced dual energy CT using a lung perfusion algorithm in assessing for post-traumatic scaphoid proximal pole avascular necrosis. Eight surgical specimens were sent to histology and showed a 100% correlation (8/8) with the DECT findings. The remaining 11 wrists that did not have a specimen sent had in-surgery findings that also correlated with DECT. A single case was discrepant (1/11) due to presence of an intra-osseous ganglion, which was reported as osteonecrosis on CT, but considered viable at surgery. No case was called viable on CT that proved to be necrotic at either surgery or histologically. 4
56. 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
57. Saupe N, Pfirrmann CW, Schmid MR, Schertler T, Manestar M, Weishaupt D. MR imaging of cartilage in cadaveric wrists: comparison between imaging at 1.5 and 3.0 T and gross pathologic inspection. Radiology. 2007;243(1):180-187. Observational-Dx 10 cadaveric wrists from 9 subjects To evaluate prospectively the diagnostic accuracy of MR imaging in the identification of cartilage abnormalities at 3.0 and 1.5 T in cadaveric wrists, with gross pathologic findings as the standard of reference. 170 cartilage surfaces were graded. The sensitivity and specificity for cartilage lesions were 43%-52% and 82%-89%, respectively, at 1.5 T and 48%-52% and 82% at 3.0 T. Differences in assessment did not reach statistical significance (P > .99). Highest sensitivities were found in the proximal carpal row (67%-71%); lowest sensitivities were found in the distal carpal row (14%-24%). Interobserver agreement was higher for imaging at 3.0 T (kappa = 0.634) than at 1.5 T (kappa = 0.267). The performance of MR imaging for the detection of articular cartilage abnormalities in the wrist depends on anatomic location. Interobserver agreement is higher for imaging at 3.0 than at 1.5 T, but diagnostic performances were not significantly different (P > .99) at either field strength. 2
58. Cerezal L, Abascal F, Canga A, Garcia-Valtuille R, Bustamante M, del Pinal F. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR Am J Roentgenol 2000;174:141-9. Observational-Dx 30 consecutive patients To identify the role of gadolinium-enhanced MR imaging in the preoperative evaluation of the vascular status of the proximal fragment in scaphoid nonunions. Unenhanced MR imaging showed a global sensitivity of 36%, specificity of 78%, and accuracy of 68% in the preoperative evaluation of the vascular status of the proximal fragment. Correlation with the surgical findings was not statistically significant (p < 0.149). Global sensitivity, specificity, and accuracy of gadolinium-enhanced MR imaging were 66%, 88%, and 83%, respectively. Correlation with the surgical findings was good (p < 0.0001). Gadolinium-enhanced sequences allowed accurate diagnosis and enabled the creation of prognostic groups having better correlation with surgical findings and postoperative results. Gadolinium-enhanced MR imaging is the most reliable imaging method for investigating the vascularity of the proximal pole in scaphoid nonunions. 2
59. Fox MG, Gaskin CM, Chhabra AB, Anderson MW. Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol 2010;195:W281-6. Observational-Dx 29 patients To evaluate the accuracy of unenhanced T1-weighted MR images in predicting the vascular status of the proximal pole of the scaphoid in patients with chronic scaphoid fracture nonunions. Unenhanced MRI had a sensitivity, specificity, and accuracy of 55%, 94%, and 79%, respectively, for diagnosing AVN. Increased proximal pole STIR signal was noted with similar frequencies in patients with and without AVN. T1-weighted unenhanced MRI is an acceptable alternative to delayed contrast-enhanced MRI in the preoperative assessment of the vascular status of the proximal pole of the scaphoid in patients with chronic fracture nonunions. STIR images were not beneficial in determining proximal pole viability. 2
60. Graham B, Peljovich AE, Afra R, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint Surg Am. 98(20):1750-1754, 2016 Oct 19. Review/Other-Dx N/A To summarize the recommendations and the ratings of the guideline on management of carpal tunnel syndrome. No results stated in abstract. 4
61. Wipperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis and Management. [Review]. Am Fam Physician. 94(12):993-999, 2016 Dec 15. Review/Other-Dx N/A To discuss the diagnosis and management of carpal tunnel syndrome. No results stated in abstract. 4
62. Ng AWH, Griffith JF, Tong CSL, et al. MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Skeletal Radiol. 49(3):397-405, 2020 Mar. Observational-Dx 69 wrists in 41 symptomatic CTS patients and 32 wrists in 28 asymptomatic subjects To study MRI criteria for diagnosing and predicting severity of carpal tunnel syndrome (CTS). ROC curve analysis revealed a sensitivity, specificity, and accuracy of median nerve CSA > 15 mm2 proximal to the tunnel (CSAp) of 85.5, 100, and 90.1%. Using either CSAp or CSAd > 15 mm2 as a diagnostic criterion, MRI could achieve a sensitivity of 100% and specificity of 94% for diagnosis of CTS while overall accuracy was 98%. Significant differences were found among the three severity groups. Sensitivity, specificity, and accuracy of prediction of severe CTS using for CSAp > 19 mm2 were 75.0, 65.9, and 69.6%, respectively. 1
63. Bagga B, Sinha A, Khandelwal N, Modi M, Ahuja CK, Sharma R. Comparison of Magnetic Resonance Imaging and Ultrasonography in Diagnosing and Grading Carpal Tunnel Syndrome: A Prospective Study. Curr Probl Diagn Radiol. 49(2):102-115, 2020 Mar - Apr. Observational-Dx 26 patients and 19 healthy controls To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction studies (NCS) as the gold standard. On USG, CA measured at PI0 (95% confidence interval of 0.872-0.987) and retinacular bowing (0.816-0.912), while, on MRI, CA at PI1 (0.874-0.997) were most useful in diagnosing CTS based on the ROC and Zombie plot analysis. Area under curves for CA measurements on USG and MRI were not significantly different. CA at PI1 on MRI (0.752-0.965) was significantly different between minimal to moderate CTS and severe to extreme CTS groups (on NCS). 2
64. Hersh B, D'Auria J, Scott M, Fowler JR. A Comparison of Ultrasound and MRI Measurements of the Cross-Sectional Area of the Median Nerve at the Wrist. Hand. 14(6):746-750, 2019 11. Observational-Dx 20 participants To compare CSA of the median nerve between US and MRI using current MRI and US technology. Four left wrists and 16 right wrists were measured. The US mean CSA of the median nerve was 6.8 mm2 (±2.330 mm2). The MRI mean CSA of the median nerve was 6.8 mm2 (±2.153 mm2), P = .442. Pearson correlation between modalities was 0.93, suggesting near-perfect correlation. Mean percent error was 8.8%. 1
65. Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res 2011;469:1089-94. Meta-analysis 3131 wrists To determine the sensitivity and the specificity of ultrasound for the diagnosis of CTS in the following three scenarios: (1) using all studies regardless of reference standard; (2) using all studies with EDX as the reference standard; and (3) using all studies with clinical diagnosis as the gold standard. The composite sensitivity and specificity of ultrasound for the diagnosis of CTS, using all studies, were 77.6% (95% CI 71.6-83.6%) and 86.8% (95% CI 78.9-94.8%), respectively. M
66. Descatha A, Huard L, Aubert F, Barbato B, Gorand O, Chastang JF. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome. Semin Arthritis Rheum 2012;41:914-22. Meta-analysis 13 studies To review and pool recent large methodological studies evaluating the diagnosis performance of ultrasonography vs electrodiagnostic testing (EDX). Among the 189 articles found, 13 articles were included. A cross-sectional area of the median nerve between 9.5 and 10.5 mm(2) (study included once only), found for 11 studies, gave the pooled sensitivity as 0.84 [0.81 to 0.87] and the likelihood ratio for a negative test as 0.21 [0.17 to 0.27]. Specificity (0.78 [0.69-0.88]) and the likelihood ratio for a positive test (3.74 [2.30-6.10]) were heterogeneous. For a threshold at 7.0 to 8.5 mm(2), pooled sensitivity was 0.94 [0.87 to 1.00], and for 11.5 to 13.0 mm(2) specificity was 0.97 [0.91 to 1.00]. The only significant variable on potential sources of heterogeneity was the cross-sectional area of the median nerve threshold and area under the curve was 0.87 (asymmetric). M
67. Torres-Costoso A, Martinez-Vizcaino V, Alvarez-Bueno C, Ferri-Morales A, Cavero-Redondo I. Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 99(4):758-765.e10, 2018 04. Meta-analysis 28 studies To evaluate the accuracy of inlet and outlet ultrasonography measurements for the diagnosis of carpal tunnel syndrome (CTS). The pooled dOR values for the diagnosis of CTS were 31.11 (95% CI, 20.42-47.40) for inlet-level and 16.94 (95% CI, 7.58-37.86) for outlet-level measurements. The 95% confidence region for the point that summarizes overall test performance of the included studies occurred where the cutoffs ranged from 9.0 to 12.6mm2 for inlet-level measurements and from 9.5 to 10.0mm2 for outlet-level measurements. Good
68. Roomizadeh P, Eftekharsadat B, Abedini A, et al. Ultrasonographic Assessment of Carpal Tunnel Syndrome Severity: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 98(5):373-381, 2019 05. Meta-analysis 16 articles To investigate the overall estimates of cross-sectional areas of the median nerve measured by ultrasonography in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. The pooled analysis revealed a mean cross-sectional area of 11.64 mm (95% confidence interval = 11.23-12.05 mm, P < 0.001) for mild carpal tunnel syndrome, a mean cross-sectional area of 13.74 mm (95% confidence interval = 12.59-14.89 mm, P < 0.001) for moderate carpal tunnel syndrome, and a mean cross-sectional area of 16.80 mm (95% confidence interval = 14.50-19.1 mm, P < 0.001) for severe carpal tunnel syndrome. Good
69. Erickson M, Lawrence M, Lucado A. The role of diagnostic ultrasound in the examination of carpal tunnel syndrome: an update and systematic review. J Hand Ther. 35(2):215-225, 2022 Apr-Jun. Review/Other-Dx 17 studies To analyze and summarize recent published data evaluating measurement properties of diagnostic ultrasound for use in individuals with CTS. Measurements of median nerve cross sectional area (CSA) taken at the carpal tunnel inlet consistently demonstrated good to excellent interrater reliability (ICC=0.83-0.93) and good intrarater reliability (r>0.81). All studies supported inlet CSA in differentiating between individuals with and without CTS. Carpal tunnel inlet CSA measurements demonstrated a moderate correlation to the Padua severity classification (r = 0.71), but this varied between studies. Diagnostic accuracy of CSA measured at the carpal tunnel inlet using diagnostic cutoff values ranging from 8.5 mm2 to 12.6 mm2 resulted in a range sensitivity (63%-96.9%) and specificity (67.9%-100%). 4
70. Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am 2014;96:e148. Observational-Dx 85 patients To compare the sensitivity and specificity of ultrasound and electrodiagnostic testing by using a validated clinical diagnostic tool as the reference standard. With use of the CTS-6 as the reference standard, ultrasound had a sensitivity of 89% and a specificity of 90% in our series of eighty-five patients. Electrodiagnostic testing had a sensitivity of 89% and a specificity of 80%. The positive predictive value of ultrasound was 94% compared with 89% for electrodiagnostic testing. The negative predictive value of ultrasound was 82% compared with 80% for electrodiagnostic testing. Ultrasound was accurate in seventy-six (89%) of the eighty-five cases whereas electrodiagnostic testing was accurate in seventy-three (86%) of the eighty-five cases (p = 0.5). 2
71. Fowler JR, Byrne K, Pan T, Goitz RJ. False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome. J Hand Surg [Am]. 44(3):181-185, 2019 Mar. Observational-Dx 40 hands To determine the rate of false positives for nerve conduction studies (NCSs) and ultrasound (US) in a population without signs and symptoms of carpal tunnel syndrome (CTS) using a CTS-6 score of 0 as the reference standard. The US was positive in 9 of 40(23%) and NCS was positive in 17 of 40 (43%). There were only 2 patients with a falsepositive US that did not also have a positive NCS. However, there were 11 patients who had a false-positive NCS that did not have a positive US. 2
72. Gervasio A, Stelitano C, Bollani P, Giardini A, Vanzetti E, Ferrari M. Carpal tunnel sonography. [Review]. J. ultrasound. 23(3):337-347, 2020 Sep. Review/Other-Dx N/A To review the anatomy of carpal tunnel syndrome and the role of ultrasound for imaging peripheral nerves and the carpal tunnel. No results stated in abstract. 4
73. Ratasvuori M, Sormaala M, Kinnunen A, Lindfors N. Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross-sectional areas and electroneuromyography. J. hand surg., Eur. vol.. 47(4):369-374, 2022 04. Observational-Dx 77 patients and 47 controls. To evaluate the usefulness of ultrasonography in diagnosing carpal tunnel syndrome (CTS). A significant correlation was found between the ultrasonography cross-sectional area values at entry points into the carpal tunnel and electroneuromyography. The highest sensitivity (87%) and specificity (91%) for different cut-off values (8.5-12.5 mm2) of the cross-sectional area was for 11.5 mm2. 3
74. Sears ED, Lu YT, Wood SM, et al. Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome. J Hand Surg [Am]. 42(8):623-629.e1, 2017 Aug. Review/Other-Dx 134 providers To evaluate how often physicians who perform carpal tunnel release in the state of Michigan routinely request electrodiagnostic studies (EDS) or other diagnostic tests prior to an initial consultation and whether provider or practice characteristics had an influence on requirements for preconsultation diagnostic tests. Among the 134 providers who were confirmed to perform carpal tunnel release, 57% (n = 76) required and 9% (n = 12) recommended a diagnostic test prior to the initial consultation. Of the 88 physicians who required/recommended testing, 85% (n = 75) requested EDS, 22% (n = 19) requested magnetic resonance imaging, 13% (n = 11) requested a computed tomography scan, and 9% (n = 8) requested an x-ray. Patients were asked to have multiple studies by 19 (22%) of the 88 surgeons who requested/recommended testing. 4
75. Tehranzadeh J, Ashikyan O, Anavim A, Tramma S. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skeletal Radiol. 2006;35(11):814-822. Observational-Dx 30 patients (72 exams) To describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7, respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb. 3
76. Clavero JA, Golano P, Farinas O, Alomar X, Monill JM, Esplugas M. Extensor mechanism of the fingers: MR imaging-anatomic correlation. Radiographics. 23(3):593-611, 2003 May-Jun. Review/Other-Dx N/A To discuss the extensor anatomy of the hand and fingers for better assessment of pathologic conditions with MR imaging. No results stated in abstract. 4
77. Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. [Review]. Radiol Clin North Am. 57(5):957-976, 2019 Sep. Review/Other-Dx N/A To review the mechanisms of injury, clinical signs and symptoms, usefulness of MR imaging and therapeutic management of overuse wrist and hand injuries. No results stated in abstract. 4
78. Kazmers NH, Gordon JA, Buterbaugh KL, Bozentka DJ, Steinberg DR, Khoury V. Ultrasonographic Evaluation of Zone II Partial Flexor Tendon Lacerations of the Fingers: A Cadaveric Study. J Ultrasound Med. 37(4):941-948, 2018 Apr. Observational-Dx 8 cadaveric specimens To evaluate ultrasonographic test characteristics and accuracy in identifying partial flexor tendon lacerations in a cadaveric model. The sensitivity and specificity in detecting the presence versus absence of a partial laceration were 0.54 and 0.75, respectively, with positive and negative likelihood ratio values of 2.17 and 0.61. For low-grade lacerations, the sensitivity and specificity were 0.25 and 0.85, compared to 0.83 and 0.85 for high-grade lacerations. Ultrasonography underestimated the percentage of tendon involvement by a mean of 18.1% for the study population as a whole (95% confidence interval, 9.0% to 27.2%; P < .001) but accurately determined the extent for correctly diagnosed high-grade lacerations (-6.7%; 95% confidence interval, -18.7% to 5.2%; P = .22). 1
79. Kwon BC, Choi SJ, Koh SH, Shin DJ, Baek GH. Sonographic Identification of the intracompartmental septum in de Quervain's disease. Clin Orthop Relat Res. 2010;468(8):2129-2134. Observational-Dx 40 patients To evaluate the accuracy of sonography for identifying the intracompartmental septum in the first extensor compartment in patients with de Quervain's disease using surgical findings as the reference standard Sonography identified the intracompartmental septum in 19 of the 19 septum-present wrists and absence of the septum in 23 of the 24 septum-absent wrists. The sensitivity of sonography was 100% (95% confidence interval, 80%-100%), its specificity 96% (95% confidence interval, 78%-100%), accuracy 98% (95% confidence interval, 87%-100%), positive predictive value 95% (95% confidence interval, 74%-100%), and negative predictive value 100% (95% confidence interval, 83%-100%). Sonography also identified septum-like structures in 15 of 37 (41%) asymptomatic contralateral wrists. Sonography is useful for detecting the intracompartmental septum in the first extensor compartment in patients with de Quervain's disease. 3
80. Bekhet CNH, Ghaffar MKA, Nassef MA, Khattab RT. Role of Ultrasound in Flexor Tendon Injuries of the Hand: A New Insight. Ultrasound Med Biol. 47(8):2157-2166, 2021 08. Observational-Dx 35 patients with penetrating trauma To validate the diagnostic accuracy of ultrasound (US) scans in pre-operative evaluation of flexor tendon injuries in the hand and to determine its value in the management of such injuries and in the prediction of patient outcome. Ultrasound results were compared with the operative findings as the gold standard test. Patients were followed up postoperatively, and functional outcome was assessed and correlated with pre-operative sonographic findings. Our results indicate that sonographic examination of hand tendon injury has high accuracy in diagnosing complete or partial flexor injuries, with 100% accuracy, sensitivity and specificity in diagnosing full-thickness tears as well as tenosynovitis of hand flexor tendons. Zonal II injury was the most frequent among our study population and correlated with poorest functional outcome after rehabilitation at 3 mo follow-up. 2
81. 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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