For the detection of lunotriquetral ligament tear, CT arthrography has approximately 100% sensitivity, 80% specificity, and 90% accuracy. Compared with arthroscopy, CT arthrography has 80% to 100% sensitivity for scapholunate and lunotriquetral ligament tears [33-35]. Compared to MR arthrography, CT arthrography detects partial ligament tears more accurately, detects articular cartilage defects more accurately, and has greater interobserver agreement [33]. Both CT arthrography and MR arthrography have a very high accuracy for diagnosing tears of the scapholunate ligament and lunotriquetral ligament; both are more accurate than conventional MRI [36]. The accuracy of CT arthrography for extrinsic ligament injuries is unknown [37]. CT Wrist CT is not indicated in this clinical setting. MRI Wrist When conventional radiographs do not show carpal malalignment, MRI is commonly used to diagnose ligamentous tears. In the clinical setting of dynamic instability, MRI or MR arthrography may be performed. Modern MR techniques using 3T systems, dedicated wrist coils, and 3-D isovolumetric sequences offer fast imaging times with high spatial and contrast resolution [36,38]. In general, 1.5T MRI has moderate sensitivity for the detection of scapholunate ligament tears and poor sensitivity for lunotriquetral ligament tears [35]. A meta-analysis of 11 studies reported sensitivities and specificities of 70% and 90% for detection of scapholunate ligament tears and 31% and 89% for detection of lunotriquetral ligament tears, respectively [39]. Sensitivity of 3T MRI is slightly better than 1.5T for the diagnosis of interosseous ligament tears. Reported sensitivities range from 65% to 89% for scapholunate ligament tears and 60% to 82% for lunotriquetral ligament Acute Hand and Wrist Trauma tears [36,40-42]. Some investigators consider the diagnostic accuracy of 3T MRI and MR arthrography to be comparable [38]. The accuracy of MRI for extrinsic ligament assessment is unknown [37].
Acute Hand and Wrist Trauma. For the detection of lunotriquetral ligament tear, CT arthrography has approximately 100% sensitivity, 80% specificity, and 90% accuracy. Compared with arthroscopy, CT arthrography has 80% to 100% sensitivity for scapholunate and lunotriquetral ligament tears [33-35]. Compared to MR arthrography, CT arthrography detects partial ligament tears more accurately, detects articular cartilage defects more accurately, and has greater interobserver agreement [33]. Both CT arthrography and MR arthrography have a very high accuracy for diagnosing tears of the scapholunate ligament and lunotriquetral ligament; both are more accurate than conventional MRI [36]. The accuracy of CT arthrography for extrinsic ligament injuries is unknown [37]. CT Wrist CT is not indicated in this clinical setting. MRI Wrist When conventional radiographs do not show carpal malalignment, MRI is commonly used to diagnose ligamentous tears. In the clinical setting of dynamic instability, MRI or MR arthrography may be performed. Modern MR techniques using 3T systems, dedicated wrist coils, and 3-D isovolumetric sequences offer fast imaging times with high spatial and contrast resolution [36,38]. In general, 1.5T MRI has moderate sensitivity for the detection of scapholunate ligament tears and poor sensitivity for lunotriquetral ligament tears [35]. A meta-analysis of 11 studies reported sensitivities and specificities of 70% and 90% for detection of scapholunate ligament tears and 31% and 89% for detection of lunotriquetral ligament tears, respectively [39]. Sensitivity of 3T MRI is slightly better than 1.5T for the diagnosis of interosseous ligament tears. Reported sensitivities range from 65% to 89% for scapholunate ligament tears and 60% to 82% for lunotriquetral ligament Acute Hand and Wrist Trauma tears [36,40-42]. Some investigators consider the diagnostic accuracy of 3T MRI and MR arthrography to be comparable [38]. The accuracy of MRI for extrinsic ligament assessment is unknown [37].