MRI and MR Arthrography
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.