Extensor carpi ulnaris (ECU) subsheath: Normal MRI appearance and findings in athletic injuries : 40
2010
Purpose: First, to report ECU subsheath's normal MRI appearance
and the findings in athletic injuries. Second, to determine the best MRI
sequence for diagnosis.
Methods and materials: Sixteen patients (13 males, 3 females, mean
age 30.3 years) with ECU subsheath's athletic injuries sustained
between January 2003 and June 2009 were retrospectively reviewed.
Wrist MRI studies were performed on 1.5-T units and consisted of at
least transverse T1 and STIR sequences in pronation, and FS Gd T1
in pronation and supination. Two radiologists assessed the following
items, in consensus: injury type (A to C according to Inoue), ECU
tendon stability, and associated lesions (ulnar head oedema, extensor
retinaculum injury, ECU tendinosis and tenosynovitis). Then, each
reader independently rated the sequences' diagnostic value:
0 = questionable, 1 = suggestive, 2 = certain. Follow-up studies were
present in 8 patients. ECU subsheath's normal visibility (medial, central
and lateral parts) was retrospectively evaluated in 30 consecutive
control MRI studies.
Results: FS Gd T1 sequences in supination (1.63) and pronation (1.59)
were the most valuable for diagnosis, compared to STIR (1.22) and T1
(1). The study group included 9 type A, 1 type B and 6 type C injuries.
There were trends towards diminution in pouches' size, signal intensity
and enhancement in follow-up studies, along with tendon stabilization
within the ulnar groove. In control studies, ECU subsheath's visibility in
medial, central and lateral parts were noted in 66.7-80%, 63.3-80%
and 30-50% respectively.
Conclusion: ECU subsheath's athletic injuries are visible on 1.5-T MRI
studies. FS Gd T1 sequences in supination and pronation are the most
valuable.
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