State-of-the-art imaging of wrist ligaments
MSK section at Department of Radiological Sciences at UCI Medical Center is providing state-of-the -art high-resolution MRI of the wrist. This advanced imaging that uses 3T MRI scanners includes isotropic 3D fast spin echo (FSE) proton density-weighted sequence with or without fat suppression, obtained with a 7 cm field of view (FOV), 0.35 mm voxel size, and approximately 5 minutes scan time.
55 year old female: TFCC injury (MR arthrogram at 3T)
Originally, this isotropic 3D FSE sequence was developed by research collaboration between Philips Healthcare and UCIMC radiologists. It is now available as part of routine clinical imaging for our patients at UCIMC. Many peer-reviewed scientific articles have been published by UCI physicians showing the advantages of this high resolution scanning. Isotropic 3D MRI of the wrist allows us to evaluate small complicated ligaments and other structures of the wrist, especially the triangular fibrocartilage complex (TFCC), otherwise difficult to see with other techniques. The TFCC is a fibrocartilage–ligament complex which stabilizes the distal radioulnar joint of the wrist, transmits axial load between the carpus and the ulna, and stabilizes the ulnar aspect of the carpus. The most common mechanism of injury is a fall onto an outstretched hand. Patients at the greatest risk for TFCC injury are athletes involved in high demand sports such tennis players and gymnasts. The patient presenting with wrist pain of ulnar structural origin may present with either diffuse pain referred across the wrist or focal ulnar-sided pain. Pain is exacerbated by activities or positioning involving ulnar directed wrist deviation and forearm rotation. MR wrist arthrogram is often used to image the TFCC, allowing for improved visualization of the closely grouped ligamentous structures following distention of the joint with injected contrast. When evaluating isotropic 3D images, we use a real-time multiplanar reconstruction (MPR) function at workstation, which is able to more accurately demonstrate a focal tear of the TFCC and other subtle pathologies.
Hiroshi Yoshioka, MD, PhD