MDCT arthrography assessment of the severity of cartilage damage and scapholunate dissociation in regard to specific-component tears of the scapholunate interosseous ligament.

PURPOSE: To evaluate the distribution and severity of cartilage damage and scapholunate dissociation assessed on multi-detector computer tomography (MDCT) arthrography in a sample of patients with scapholunate interosseous ligament (SLIL) injury, in regard to component-specific tears. METHODS: We retrospectively included 37 patients with SLIL tears and 34 patients without SLIL tears who served as controls, all patients had undergone MDCT arthrography. Morphology of SLIL dorsal and volar components was graded as: normal, partial, or complete tear. Cartilage damage was assessed in 14 distinct regions of the wrist using a semiquantitative modified scoring system. Staging of scapholunate advanced collapse (SLAC) for each patient was based on the distribution of cartilage damage seen on MDCT arthrography. Scapholunate dissociation was measured for each patient at the tenth of a millimeter. The Student's t-test (p) and the Wilcoxon Rank-Sum test (P) were used to compare the different groups. RESULTS: The cartilage damage scores obtained were greater in patients with complete SLIL dorsal component tear than in other patients (p = 0.0019 and P = 0.0018). Scapholunate dissociation was greater in these patients (p = 0.0003 and P = 0.0013). Scapholunate dissociation was also greater in patients with SLAC wrist (p = 0.0004 and P = 0.0012), with a cut-off value of 3.7 mm for diagnosing SLAC (sensitivity 83.3 % and specificity 89.5 %). CONCLUSION: MDCT arthrography assessment shows that the severity of cartilage damage and scapholunate dissociation is greater when the dorsal component of the SLIL is completely ruptured.

MDCT arthrography assessment of scaphoid nonunion advanced collapse: distribution of cartilage damage and relationship with scaphoid nonunion features.

OBJECTIVES: Our primary aim was to evaluate the distribution and severity of cartilage damage in a sample of patients with scaphoid nonunion advanced collapse (SNAC), assessed on MDCT arthrography, with regard to two well-known SNAC staging systems. Secondarily, we wanted to see if the degree of cartilage damage varied with the location of the nonunion. METHODS: We retrospectively included 35 patients with a history of SNAC who had undergone MDCT arthrography. The location of the fracture was defined as the proximal, middle, or distal third of the scaphoid. Cartilage damage was assessed in 14 distinct regions of the wrist using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Staging of SNAC for each patient was based on the distribution of cartilage damage seen on MDCT arthrography. The one-way ANOVA test was used to evaluate whether global cartilage damage scores differed between patients with proximal vs middle and distal nonunion. RESULTS: The radial styloid-scaphoid (85.7%), the scaphoid-trapezium-trapezoid (60%), the scapho-capitate (57.1%), and the proximal radio-scaphoid joints (42.9%) were most commonly affected by degenerative cartilage damage. A substantial number of patients could not be classified according to the two SNAC staging systems. Patients with proximal nonunion exhibited a higher mean score of global cartilage damage than patients with middle or distal nonunion: 14.3 ± 9.5 (95% CI 9.8, 18.7) vs 8.6 ± 6.9 (95% CI 4.7, 12.4); p < 0.0001. CONCLUSION: The distribution of cartilage damage does not always follow the pattern of progressive osteoarthritis widely described in SNAC. Proximal scaphoid nonunion is related to greater severity of global cartilage damage.

Rheumatoid arthritis of the hand: monitoring with a simplified MR imaging scoring method--preliminary assessment.

PURPOSE: To assess a simplified scoring method (Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score [SAMIS]) developed to shorten interpretation time, while retaining both correlation with Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) and same or better intra- and interreader reliability. MATERIALS AND METHODS: Ethics board approval and written patient consent were obtained. The study was HIPAA compliant. Thirty-eight patients with rheumatoid arthritis and 20 patients with no or early unclassified arthritis underwent magnetic resonance imaging of both wrists and hands. RAMRIS was used to evaluate erosions (scale, 0-10), edema (scale, 0-3), and synovitis (scale, 0-3). SAMIS assessed only one hand and was based on the radiographic Simple Erosion Narrowing Score, thus reducing the number of study areas from 116 to 36. Erosions were scored with a scale from 1 to 10. Edema and synovitis were, respectively, scored with scales from 0 to 1 and 0 to 2. SAMIS correlation with RAMRIS was tested by using the Spearman test. Last, the intra- and interobserver reproducibility of both scores were calculated. RESULTS: SAMIS was closely correlated with RAMRIS for the entire series (r = 0.91, 0.79, and 0.94, respectively, for erosion, edema, and synovitis), as well as in patients with rheumatoid arthritis (r = 0.93, 0.81, and 0.92) and those with no or unclassified arthritis (r = 0.83, 0.73, and 0.94). The time needed to assess examination results with RAMRIS ranged from 5 to 20 minutes (13 minutes +/- 3.90 [standard deviation]), whereas it ranged from 2 to 7 minutes (5 minutes +/- 1.45) with SAMIS. For each of the three features (erosion, edema, and synovitis), intraobserver agreement (RAMRIS: kappa = 0.67, 0.94, 0.81, respectively; SAMIS: kappa = 0.66, 1.0, 0.91) and interobserver agreement (RAMRIS: kappa = 0.61, 0.58, 0.74, respectively; SAMIS: kappa = 0.59, 0.81, 0.81) were good to excellent. CONCLUSION: This simplified reproducible scoring scheme could be used to monitor joint damage in rheumatoid arthritis. (c) RSNA, 2010.