Cartilage Specific MR Sequences in Assessment of Lunate Types and Their Impact on Triangular Fibrocartilage

Abstract

Objectives: Our purpose was to investigate the effects of different lunate morphologies on triangular fibrocartilage (TFC) using cartilage specific magnetic resonance imaging (MRI) sequences. Secondarily, we aimed to define better parameters to discriminate two lunate types on MRI and posteroanterior wrist radiographs. Materials and Methods: Wrist MRIs of 118 cases with neutral ulnar variance were retrospectively assessed for lunate types based on the presence of abutting articular cartilage between lunate and hamate on coronal 3D dual echo steady state and 2D multi-echo data image combination images. Posteroanterior radiographs were assessed separately. TFC and cartilage lesions on hamate and lunate were assessed on MRI. Lunate-hamate (L-H) and capitate-triquetrum (C-T) distances were measured on coronal MRI and radiographs. Relationship between lunate types and cartilage lesions were evaluated using X2, Fisher’s exact test, t-test or Mann-Whitney U test. ROC analysis was used to determine cut-off values to best discriminatethe two lunate types. Results: Mean age was 38.5±13.4 (M:F=33:85). TFC or lunate cartilage lesions showed no correlation with lunate types. L-H/C-T ratio of 0.907 on MRI and 0.75 on radiographs yielded the highest sensitivity and specificity for discrimination of lunate types. Type 2 morphology was correlated with cartilage degeneration on hamate (p=0.003). Cartilage lesions on hamate, lunate and TFC were significantly correlated with age (p=0.008, p=0.003, p<0.001 respectively). Conclusion: Lunate types had no impact on degenerative changes of TFC or lunate-sided cartilage damage in wrists with neutral ulnar variance, however type 2 morphology was highly correlated with hamate-cartilage degeneration. Age was correlated with degenerative findings on all cartilage surfaces.

Keywords

• Hamatolunate Impingement
• Lunate Morphology
• MRI
• Radiographs
• Wrist

Kıkırdağa Özgün MR Sekansları ile Lunat Tipleri ve Bunların Triangüler Fibrokartilaja Etkisinin Değerlendirilmesi

Abstract

Amaç: Amacımız, kıkırdağa özgün manyetik rezonans görüntüleme (MRG) sekansları kullanarak değişik lunat morfolojilerinin triangüler fibrokartilaj (TFK) üzerindeki etkilerini araştırmaktı. İkincil olarak MRG ve posteroanterior el bilek grafilerinde lunat tiplerini ayırmada daha iyi parametreler tanımlamayı amaçladık. Gereç ve Yöntem: Koronal 3B dual echo steady state ve 2D multi-echo data image combination MR görüntüleri kullanılarak 118 nötral varyanslı el bileği MR incelemesinde lunat ve hamat kemiklerin karşılıklı temas eden kıkırdak yüzeyi olup olmamasına göre lunat tiplendirmesi yapıldı. Ayrı bir seansta posteroanterior el bilek grafilerinde lunat tipleri değerlendirildi. MRG’de TFK, hamat ve lunat eklem kıkırdak lezyonları değerlendirildi. Koronal MRG ve grafilerden lunat-hamat (L-H) ve kapitat-trikuetrum (K-T) mesafeleri ölçüldü. Lunat tipleri ile kıkırdak lezyonları arasındaki ilişkinin değerlendirilmesinde X2, Fisher’s exact test, t-test veya Mann-Whitney U testleri kullanıldı. İki lunat tipini ayırmada en iyi eşik değeri tespit etmede ROC eğrisi analizi kullanıldı. Bulgular: Ortalama yaş 38,5±13,4 (E:K=33:85) idi. TFC ve lunat kıkırdak lezyonları ile lunat tipleri arasında ilişki saptanmadı. MR’de L-H/K-T MR için 0,907, direct grafilerde 0,75 lunat tiplerini ayırmada en yüksek duyarlılık ve özgüllüğü gösterdi. Tip 2 morfoloji hamatta kıkırdak dejenerasyonu ile korele bulundu (p=0,003). Yaş, hamat, lunat ve TFC kıkırdak lezyonları ile ilişkili bulundu (sırasıyla p=0,008, p=0,003, p<0,001). Sonuç: Nötral varyanslı el bileklerinde lunat tiplerinin TFC ve lunat kıkırdak üzerinde etkisi gözlenmezken tip 2 lunat morfolojisi hamat kıkırdak dejenerasyonu ile korele bulundu. Yaş, her üç kıkıdak yüzeydeki dejeneratif değişiklikler ile koreleydi.

Keywords

• Hamatolunat Sıkışma
• Lunat Morfolojisi
• MRG
• Direkt Grafi
• El Bileği

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