Abstract
Background We sought to evaluate the interobserver and intraobserver reliability of radiographs
and magnetic resonance imaging (MRI) for grading of osteoarthritis in patients with
scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC),
and to determine whether MRI is more likely than radiographs to detect carpal osteoarthritis.
Methods Radiographs and MR studies of 46 patients with SLAC and SNAC arthritis were reviewed
by two hand surgeons and two radiologists and were graded according to severity of
osteoarthritis at seven carpal joints. Interobserver and intraobserver reliability
was assessed using a weighted kappa analysis. Odds ratios were calculated to compare
the likelihood of MRI versus radiographs in the determination of moderate or severe
osteoarthritis.
Results Measures of reliability were higher for MRI than radiographs. For radiographic assessment
of all patients combined, interobserver agreement was moderate and intraobserver agreement
was also moderate. For MRI, interobserver agreement was substantial and intraobserver
agreement was almost perfect. In all joints combined for patients with SLAC and SNAC,
MRI was 2.42 times more likely to demonstrate moderate osteoarthritis compared with
radiographs. In patients with SLAC, MRI was 11.73 times more likely than radiographs
to show moderate osteoarthritis at the radiolunate joint. In patients with SNAC, there
was no difference in demonstration of moderate osteoarthritis on MRI compared with
radiographs.
Conclusion Carpal osteoarthritis can be more reliably assessed on MRI than radiographs. MRI
is more sensitive at demonstrating moderate changes of osteoarthritis than radiographs,
especially at the radiolunate joint in patients with SLAC arthritis. This has implications
for surgical management of SLAC/SNAC arthritis and preoperative planning. MRI should
be included in the diagnostic workup and evaluation of patients with SLAC and SNAC
arthritis.
Level of Evidence Diagnostic III.
Keywords
scapholunate advanced collapse - scaphoid nonunion advanced collapse - magnetic resonance
imaging - radiographs
