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Keywords:
Image verification, Normal variants, Imaging sequences, Diagnostic procedure, Image manipulation / Reconstruction, MR, Musculoskeletal joint, Extremities, Trauma
Authors:
H. Yoshioka1, J. Sutherland1, W. Wu2, T. Nozaki1, Y. Kaneko1, H. Yu1, G. Rafijah1, D. Hitt3; 1Orange, CA/US, 2Irvine, CA/US, 3Cleveland, OH/US
DOI:
10.1594/ecr2015/C-0123
Methods and materials
This study was approved by the institutional review board at our institute.
We examined morphology and variations of the ulnar and RCLs of the wrist in 34 subjects (21 males and 13 females; 11 asymptomatic normal volunteers and 23 patients with wrist pain) with high-resolution 3D isotropic and 2D FSE MR images at 3T MRI.
Subjects ranged in age from 15 to 84 years,
with a mean of 46.5 years (42.9 years for volunteers and 48.3 years for patients).
All MR images were obtained using an 8-channel wrist coil at a 3T system (Achieva TX,
Philips Healthcare®,
Best,
The Netherlands).
Each subject was placed in supine position with the wrist at side of the body and neutral forearm position. The following MRI sequences were reviewed for evaluation of this study; coronal 3D isotropic FSE proton density weighted images (PDWI): TR (repetition time)/TE (echo time) = 1400/28.3 msec,
voxel size = 0.35x0.35x0.35 mm,
gap= 0mm,
FOV = 70 mm,
coronal 2D FSE PDWI for volunteers: TR/TE = 3181/27 msec,
voxel size = 0.23x.033x2.0 mm,
gap = 0.2mm,
FOV = 70 mm,
and coronal 2D FSE PDWI for patients: TR/TE = 2863-4136/27 msec,
voxel size = 0.23-0.36x0.31-0.50x2.0 mm,
gap = 0.2mm,
FOV = 90 mm.
A parallel imaging technique named sensitivity encoding (SENSE) was used both in 2D and 3D sequences.
All 3D images were obtained combined with driven equilibrium (DRIVE) technique.
Acquisition time was 5 min and 4 sec for 3D isotropic MR images and 2 min 39 sec to 3 min 29 sec for 2D FSE sequence.
For qualitative UCL analysis,
the attachment location and width to the ulnar styloid process of the UCL was evaluated using isotropic 3D and conventional 2D sequences.
The attachment location and width of the UCL was classified into 4 types (type 1a: narrow attachment to tip of the ulnar styloid (Tip),
type 1b: broad attachment to Tip,
type 2a: narrow attachment to medial base of the ulnar styloid (Base),
type 2b: broad attachment to Base; Figure 1).
First,
routinely reconstructed coronal 2D and 3D images were used for the analysis.
Then,
oblique coronal multiplanar reconstruction (MPR) images created from original coronal isotropic 3D images were used for confirmation of the UCL attachment.
Connection of the UCL to the triangular ligament of the TFCC is also evaluated.
For qualitative RCL analysis,
the RCL width to the scaphoid and extension to the trapezium was evaluated using isotropic 3D and conventional 2D sequences.
The attachment width and extension of the RCL has been classified into 4 types (type 1a: separated radioscaphoid and scaphotrapezium ligaments (RS+ST) with narrow scaphoid attachment,
type 1b: RS+ST with broad scaphoid attachment,
type 2a: continuous radioscaphoid and scaphotrapezium ligaments (RST) with narrow scaphoid attachment,
type 2b: RST with broad scaphoid attachment; Figure 2).
Anatomic delineation of the UCL and RCL were semiquantitatively evaluated with 3D and 2D sequences according to the following 5-point scorings: 4; excellent,
3; good,
2; satisfactory,
1; poor,
and 0; non-identified.
The Wilcoxon Signed-Rank Test was used to determine the significance of the differences in scores between high-resolution isotropic 3D and conventional 2D sequences.
In each analysis,
a P value of ≤ 0.05 was considered significant.