Added Diagnostic Value of CT Arthrography to MR Arthrography in Wrist Internal Derangement

N/ANot Yet RecruitingNCT07826208

Assiut University60 enrolled

Overview

The wrist is a complex joint made up of small bones, cartilage, and stabilizing ligaments, including the triangular fibrocartilage complex (TFCC) and intrinsic carpal ligaments. Because these structures are small and intricate, diagnosing internal joint damage (internal derangement) after trauma or chronic pain can be challenging. Magnetic resonance arthrography (MRA), an imaging scan performed after injecting a contrast dye into the joint, is widely used because it shows soft tissues clearly. However, MRA can sometimes miss subtle bone fragments, cartilage defects, or partial ligament tears due to lower spatial resolution. Computed tomography arthrography (CTA) provides higher-detail spatial imaging and excels at identifying small bone injuries and ligament tears, though it offers less soft-tissue contrast than MRI. The purpose of this study is to determine whether performing CT arthrography in addition to MR arthrography improves the detection and characterization of internal wrist pathologies compared with MR arthrography alone. Participants enrolled in this study will: * Undergo a clinical history taking and examination regarding their wrist symptoms. * Receive an ultrasound-guided injection into the radiocarpal joint using a sterile mixture containing iodinated contrast, gadolinium contrast, saline, and a local numbing medication (xylocaine). * Undergo a high-resolution CT scan of the wrist immediately following the injection. * Undergo a 1.5T MR arthrography scan. Researchers will compare the findings between the two imaging techniques to evaluate how often adding CT arthrography identifies additional lesions that were occult or inconclusive on MR arthrography.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Interventions

Combined CT Arthrography and MR ArthrographyDIAGNOSTIC_TEST

Under high-resolution ultrasound guidance, an intra-articular radiocarpal injection of approximately 5 mL is administered using a sterile mixture of iodinated contrast, gadolinium-based contrast, sterile saline, and xylocaine. Immediately following injection, high-resolution CT arthrography is performed with 0.6 mm slice thickness and multiplanar reconstruction in axial, coronal, and sagittal planes. Participants subsequently undergo 1.5T MR arthrography using coronal T2 SPIR (pre-contrast) and axial, coronal, and sagittal T1 SPIR sequences (post-contrast) using a dedicated wrist coil to evaluate internal derangement.

Eligibility

Sex: ALLMin age: 15 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 15 to 60 years. * Clinically suspected ligamentous, cartilage, tendon, or occult osseous wrist injury. * Patients scheduled for MR arthrography of the wrist. Exclusion Criteria: * History of previous wrist surgery. * Acute fractures requiring emergency management. * Active wrist infection. * Contraindications to iodinated or gadolinium-based contrast agents. * Regional metallic implants causing significant imaging artifacts. * Pregnancy.

Outcomes

Primary Outcomes

Percentage of Patients With Additional Wrist Pathologies Detected by Adding CT Arthrography to MR Arthrography

Assessed as the proportion of participants in whom CT arthrography identifies additional internal derangement lesions (including intrinsic scapholunate and lunotriquetral ligament tears, central triangular fibrocartilage complex tears, cartilage defects, and occult osseous abnormalities) that were missed, occult, or inconclusive on MR arthrography alone.

Time frame: Baseline