MRI and MR Arthrography

Part of the Medical Radiology book series (MEDRAD)


The complex anatomical nature of the hand and wrist brings about diagnostic challenges both for the Clinician and the Radiologist when considering pathology in this region. MR is a proven, widely employed imaging modality used in the detection, assessment and follow-up of disorders of both the hand and the wrist. Optimisation of both sequences and protocols are essential in order to provide good quality images which allow high sensitivity and specificity for detection of pathology. High field strength units are usually used in hand and wrist imaging alongside dedicated extremity coils. Even then, there are numerous artefacts which may be encountered including movement, pulsation, truncation, magic angle and chemical shift. These phenomena will be discussed in this chapter in addition to a brief outline of sequences and their potential uses. Pathology relating to osseous structures, tendons, TFCC and both intrinsic and extrinsic ligaments are all readily assessed on MR imaging and the optimal planes for imaging are discussed alongside common pathologies and potential pitfalls in image interpretation. MR arthrography is also discussed with particular reference to both TFCC and intrinsic ligament pathology. Recent advances in technology, including the advent of 7T units, have led to improvements in the assessment of articular cartilage at the wrist and techniques of biological imaging, which continue to evolve.


Ulnar Collateral Ligament Gradient Echo Articular Disc Scapholunate Ligament Carpal Instability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alam F, Schweitzer ME, Li XX, Malat J, Hussain SM (1999) Frequency and spectrum of abnormalities in the bone marrow of the wrist: MR imaging findings. Skeletal Radiol 28(6):312–317PubMedCrossRefGoogle Scholar
  2. Amrami KK, Felmlee JP (2008) 3-Tesla imaging of the wrist and hand: techniques and applications. Semin musculoskelet radiol 12(3):223–237PubMedCrossRefGoogle Scholar
  3. Barth MM, Smith MP, Pedrosa I, Lenkinski RE, Rofsky NM (2007) Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 27(5):1445–1462 discussion 1462–1444PubMedCrossRefGoogle Scholar
  4. Blackband SJ, Chakrabarti I, Gibbs P, Buckley DL, Horsman A (1994) Fingers: three-dimensional MR imaging and angiography with a local gradient coil. Radiology 190(3):895–899PubMedGoogle Scholar
  5. Breitenseher MJ, Metz VM, Gilula LA, Gaebler C, Kukla C, Fleischmann D et al (1997) Radiographically occult scaphoid fractures: value of MR imaging in detection. Radiology 203(1):245–250PubMedGoogle Scholar
  6. Brown JA, Janzen DL, Adler BD, Stothers K, Favero KJ, Gropper PT et al (1994) Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain. Can Assoc Radiol J 45(4):292–296PubMedGoogle Scholar
  7. Burns JE, Tanaka T, Ueno T, Nakamura T, Yoshioka H (2011) Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. Radiographics : a review publication of the Radiological Society of North America 31(1):63–78CrossRefGoogle Scholar
  8. Cantor RM, Stern PJ, Wyrick JD, Michaels SE (1994) The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study. J Hand Surg 19(6):945–953CrossRefGoogle Scholar
  9. Cerezal L, Abascal F, Garcia-Valtuille R, Del Pinal F (2005) Wrist MR arthrography: how, why, when. Radiologic clin N Am 43(4):709–731CrossRefGoogle Scholar
  10. Farooki S, Ashman CJ, Yu JS, Abduljalil A, Chakeres D (2002) In vivo high-resolution MR imaging of the carpal tunnel at 8.0 tesla. Skeletal Radiol 31(8):445–450PubMedCrossRefGoogle Scholar
  11. Gold GE, McCauley TR, Gray ML, Disler DG (2003) What’s new in cartilage? Radiographics : a review publication of the Radiological Society of North America 23(5):1227–1242CrossRefGoogle Scholar
  12. Haims AH, Moore AE, Schweitzer ME, Morrison WB, Deely D, Culp RW et al (2004) MRI in the diagnosis of cartilage injury in the wrist. AJR Am J Roentgenol 182(5):1267–1270PubMedCrossRefGoogle Scholar
  13. Haims AH, Schweitzer ME, Morrison WB, Deely D, Lange RC, Osterman AL et al (2003) Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology 227(3):701–707PubMedCrossRefGoogle Scholar
  14. Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD et al (2000) Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 217(1):201–212PubMedGoogle Scholar
  15. Hunter JC, Escobedo EM, Wilson AJ, Hanel DP, Zink-Brody GC, Mann FA (1997) MR imaging of clinically suspected scaphoid fractures. AJR Am J Roentgenol 168(5):1287–1293PubMedCrossRefGoogle Scholar
  16. Kessler I, Silberman Z (1961) An experimental study of the radiocarpal joint by arthrography. Surg Gynecol Obstet 112:33–40PubMedGoogle Scholar
  17. Kocharian A, Adkins MC, Amrami KK, McGee KP, Rouleau PA, Wenger DE et al (2002) Wrist: improved MR imaging with optimized transmit-receive coil design. Radiology 223(3):870–876PubMedCrossRefGoogle Scholar
  18. Levinsohn EM, Palmer AK, Coren AB, Zinberg E (1987) Wrist arthrography: the value of the three compartment injection technique. Skeletal Radiol 16(7):539–544PubMedCrossRefGoogle Scholar
  19. Levinsohn EM, Rosen ID, Palmer AK (1991) Wrist arthrography: value of the three-compartment injection method. Radiology 179(1):231–239PubMedGoogle Scholar
  20. Magee T (2009) Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 192(1):80–85PubMedCrossRefGoogle Scholar
  21. Malfair D (2008) Therapeutic and diagnostic joint injections. Radiologic Clin N Am 46(3):439–453CrossRefGoogle Scholar
  22. Manaster BJ (1991) The clinical efficacy of triple-injection wrist arthrography. Radiology 178(1):267–270PubMedGoogle Scholar
  23. Medverd JR, Pugsley JM, Harley JD, Bhargava P (2011) Lateral approach for radiocarpal wrist arthrography. AJR Am J Roentgenol 196(1):W58–W60PubMedCrossRefGoogle Scholar
  24. Moser T, Dosch JC, Moussaoui A, Dietemann JL (2007) Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 188(5):1278–1286PubMedCrossRefGoogle Scholar
  25. Mutimer J, Green J, Field J (2008) Comparison of MRI and wrist arthroscopy for assessment of wrist cartilage. J Hand Surg 33(3):380–382Google Scholar
  26. Nakamura T, Yabe Y, Horiuchi Y (1996) Functional anatomy of the triangular fibrocartilage complex. J Hand Surg 21(5):581–586Google Scholar
  27. Omlor G, Jung M, Grieser T, Ludwig K (2009) Depiction of the triangular fibro-cartilage in patients with ulnar-sided wrist pain: comparison of direct multi-slice CT arthrography and direct MR arthrography. Eur Radiol 19(1):147–151PubMedCrossRefGoogle Scholar
  28. Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack RR Jr (1997) The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg 79(11):1675–1684PubMedGoogle Scholar
  29. Roemer PB, Edelstein WA, Hayes CE, Souza SP, Mueller OM (1990) The NMR phased array. MRM: official journal of the society of magnetic resonance in medicine/society of magnetic resonance in medicine 16(2):192–225CrossRefGoogle Scholar
  30. Ruegger C, Schmid MR, Pfirrmann CW, Nagy L, Gilula LA, Zanetti M (2007) Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol 188(1):187–192PubMedCrossRefGoogle Scholar
  31. Saupe N, Prussmann KP, Luechinger R, Bosiger P, Marincek B, Weishaupt D (2005) MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging–preliminary experience. Radiology 234(1):256–264PubMedCrossRefGoogle Scholar
  32. Schmid MR, Schertler T, Pfirrmann CW, Saupe N, Manestar M, Wildermuth S et al (2005) Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology 237(3):1008–1013PubMedCrossRefGoogle Scholar
  33. Stevens KJ, Wallace CG, Chen W, Rosenberg JK, Gold GE (2011) Imaging of the wrist at 1.5 Tesla using isotropic three-dimensional fast spin echo cube. JMRI 33(4):908–915PubMedCrossRefGoogle Scholar
  34. Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P et al (2005) High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 52(8):2355–2365PubMedCrossRefGoogle Scholar
  35. Theumann NH, Pfirrmann CW, Antonio GE, Chung CB, Gilula LA, Trudell DJ et al (2003) Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Radiology 226(1):171–179PubMedCrossRefGoogle Scholar
  36. Wilson AJ, Gilula LA, Mann FA (1991) Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases. AJR Am J Roentgenol 157(1):105–109PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Royal United HospitalBathUK
  2. 2.Department of Musculoskeletal RadiologyChapel Allerton Orthopaedic CentreLeedsUK

Personalised recommendations