@article{GietzenKunzLuetkensetal.2022,
  author    = {Gietzen, Carsten Herbert and Kunz, Andreas Steven and Luetkens, Karsten Sebastian and Huflage, Henner and Christopoulos, Georgios and van Schoonhoven, J{\"o}rg and Bley, Thorsten Alexander and Schmitt, Rainer and Grunz, Jan-Peter},
  title     = {Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist},
  series = {BMC Musculoskeletal Disorders},
  volume    = {23},
  journal   = {BMC Musculoskeletal Disorders},
  number    = {1},
  doi       = {10.1186/s12891-022-05241-9},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301113},
  year      = {2022},
  abstract  = {Background In wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC). Methods Eighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (r\(_{ɸ}\)). Results The most common configuration of the prestyloid recess included a narrow opening (73.26\%; width 2.26 ± 1.43 mm), saccular shape (66.28\%), and palmar position compared to the styloid process (55.81\%). Its mean length and anterior-posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72\%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (r\(_{ɸ}\) = 0.480; p < 0.001), whereas no association was found for lesions of the central articular disc (r\(_{ɸ}\) = 0.172; p = 0.111). Conclusions Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist.},
  language  = {en}
}
@article{GrunzGietzenLuetkensetal.2020,
  author    = {Grunz, Jan-Peter and Gietzen, Carsten Herbert and Luetkens, Karsten and Wagner, Matthias and Kalb, Karlheinz and Bley, Thorsten Alexander and Lehmkul, Luka and van Schoonhoven, J{\"o}rg and Gassenmaier, Tobias and Schmitt, Rainer},
  title     = {The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist},
  series = {BMC Musculoskeletal Disorders},
  volume    = {21},
  journal   = {BMC Musculoskeletal Disorders},
  doi       = {10.1186/s12891-020-03321-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-236075},
  year      = {2020},
  abstract  = {Background: Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods: One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPR\(_{Standard}\)), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPR\(_{Styloid}\)) or in the ulnar fovea (MPR\(_{Fovea}\)). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer's and Atzei's classification and diagnostic confidence was stated on a fivepoint Likert scale. Results: Compared to standard planes, differentiability of the superficial and deep TFCC layer was superior in radial reconstructions (R1/R2; MPR\(_{Fovea}\): p < 0.001; MPRStyloid: p ≤ 0.007). Palmer and Atzei lesions were present in 86.8\% (92/106) and 52.8\% (56/106) of patients, respectively. Specificity, sensitivity and accuracy for central Palmer lesions did not differ in radial and standard MPR. For peripheral Atzei lesions, sensitivity (MPR\(_{Standard}\) 78.6\%/80.4\%, MPR\(_{Styloid}\) 94.6\%/94.6\%, MPR\(_{Fovea}\) 91.1\%/89.3\%) and accuracy (MPR\(_{Standard}\) 86.8\%/86.8\%, MPR\(_{Styloid}\) 96.2\%/96.2\%, MPR\(_{Fovea}\) 94.3\%/93.4\%) improved with additional styloid-centered (p = 0.004/0.008) and foveacentered (p = 0.039/0.125) reconstructions. No substantial difference was observed between both radial MPR (p = 0.688/0.250). Interrater agreement was almost perfect for each dataset (κ\(_{Standard}\) = 0.876, κ\(_{Styloid}\) = 0.894, κ\(_{Fovea}\) = 0.949). Diagnostic confidence increased with addition of either radial MPR (p < 0.001). Conclusions: Ancillary radial planes improve accuracy and diagnostic confidence for detection of peripheral TFCC lesions in CT arthrography of the wrist.},
  language  = {en}
}