The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).