Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

관절경 소견의 팔마체계와 비교한 손목관절 불안정성에 대한 동영상관절조영술의 유용성

  • Kim, Tae-Yeon (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Lee, Guen-Young (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Kim, Baek-Hyun (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Park, Jong-Woong (Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Seo, Bo-Kyoung (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Cha, Sang-Hoon (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine)
  • 김태연 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 이근영 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 김백현 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 박종웅 (고려대학교 의과대학 안산병원 정형외과) ;
  • 서보경 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 차상훈 (고려대학교 의과대학 안산병원 영상의학과)
  • Published : 2011.03.01
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Abstract

Purpose: To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings. Materials and Methods: A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5- or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values. Results: The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000). Conclusion: Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.

목적: 손목관절 인대 및 삼각섬유연골복합체 손상 진단에 관절경 결과를 바탕으로 동영상관절조영술을 자기공명관절조영술과 비교하였다. 대상 및 방법: 동영상관절조영술과 자기공명관절조영술 모두 시행한 총 38명의 환자가 연구에 포함되었다. 동영상 관절조영술은 지속적 투시장치 하 요수근관절에 조영제 주입 후 손목관절 수동운동을 하였다. 1.5T 혹은 3T MR의 축상면 및 관상면 지방억제 T1 강조영상 자기공명관절조영술을 얻었다. 주상월상인대, 월상삼각인대, 삼각섬유연골복합체 손상을 팔마 분석체계에 따라 분석, 관절경 결과를 바탕으로 두 검사를 비교, 카파 값을 구했다. 결과: 주상월상인대 및 월상삼각인대 손상은 두 검사가 비슷한 민감도, 특이도를 보였다(주상월상인대: 동영상관절조영술, 민감도 66.7% 특이도 100%; 자기공명관절조영술, 민감도 80% 특이도 95.7%) (월상삼각인대: 동영상관절조영술, 민감도 75% 특이도 94.1%; 자기공명관절조영술, 민감도 75% 특이도 91.2%). 삼각섬유연골복합체 손상은 두 검사의 정확도가 같고(민감도 96.4%, 특이도 100%) 일치도도 높았다(카파값 1.000). 결론: 동영상관절조영술은 손목관절 인대 및 삼각섬유연골복합체 손상 진단에 유용한 검사로 쓰일 수 있다.

Keywords

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