MRI of the Wrist: TFCC and Ligaments

MRI of the Wrist: MRI of the Wrist: TFCC and LigamentsTFCC and Ligaments

Garry E. Gold, M.D.Associate Professor of Radiology

Stanford University

Garry E. Gold, M.D.Associate Professor of Radiology

Stanford University

MRI ProtocolMRI Protocol8-10 cm FOVDedicated wrist coil2-3 mm slices288 x 192 matrix; paired T1 and T2-weighted imagesThin slice 3D for TFCC and ligaments“Superman” position better for imaging but worse for motionHand by side: STIR or IDEAL for fat sat

88--10 cm FOV10 cm FOVDedicated wrist coilDedicated wrist coil22--3 mm slices3 mm slices288 x 192 matrix; paired T1 and T2288 x 192 matrix; paired T1 and T2--weighted imagesweighted imagesThin slice 3D for TFCC and ligamentsThin slice 3D for TFCC and ligaments““SupermanSuperman”” position better for imaging position better for imaging but worse for motionbut worse for motionHand by side: STIR or IDEAL for fat satHand by side: STIR or IDEAL for fat sat

MRI ProtocolRoutine MRI wrist:-Tendon pathology-Carpal tunnel syndrome-Ganglion cyst-Acute trauma-Osteoarthritis-AVNMRI wrist with IV contrast:-Mass-Infection-Inflammatory arthropathyMR arthrogram:-Ligament tear

3.0T Protocol3.0T Protocol

Coronal T1 Coronal T2

2 mm slices, 288x192 matrix, 8 cm FOV8-channel phased array coil

New Sequence:3D FSE Cube

New Sequence:3D FSE Cube

3D FSE CUBE Wrist at 1.5T

0.5 mm isotropic resolution

Coronal Reformat Sagittal Source

Ligament tear

• Intrinsic ligaments• Scapholunate• Lunotriquetral• Triangular fibrocartilage complex

• central (radial aspect)• peripheral (ulnar side)

•MR arthrography•Increases accuracy for dx of tear

Intrinsic Ligaments of WristIntrinsic Ligaments of WristScapholunate Ligament

Volar, central, dorsal (most important) Central may have asymptomatic perforationTears lead to dorsal intercalated segmental instability (DISI)

Lunotriquetral LigamentSmallerTears lead to volar intercalated segmental instability (VISI)

Scapholunate LigamentScapholunate LigamentVolar, central, dorsal (most important) Volar, central, dorsal (most important) Central may have asymptomatic Central may have asymptomatic perforationperforationTears lead to dorsal intercalated Tears lead to dorsal intercalated segmental instability (DISI)segmental instability (DISI)

Lunotriquetral LigamentLunotriquetral LigamentSmallerSmallerTears lead to volar intercalated Tears lead to volar intercalated segmental instability (VISI)segmental instability (VISI)

Intercarpal ligamentsIntercarpal ligaments

Primal Pictures

Scapholunate ligament tear

-Lunotriquetral ligament tear

Eugene McNally, M.D.

Eugene McNally, M.D.

Ulnar collateral ligament tear

Stener lesion

Stener lesion

“Yo-yo” sign of a Stener lesion

Triangular Fibrocartilage Complex anatomy

Triangular Fibrocartilage Complex anatomy

Located in unlar-carpal spaceAttaches to the fovea at the base of the ulnar styloid process Attaches to the ulnar aspect of the lunate fosse of the radiusHyaline cartilage interposed between the TFCC and radius

Located in unlarLocated in unlar--carpal spacecarpal spaceAttaches to the fovea at the base of the Attaches to the fovea at the base of the ulnar styloid process ulnar styloid process Attaches to the ulnar aspect of the Attaches to the ulnar aspect of the lunate fosse of the radiuslunate fosse of the radiusHyaline cartilage interposed between Hyaline cartilage interposed between the TFCC and radiusthe TFCC and radius

TFC ContinuedTFC Continued

Meniscus homologueThickening on ulnar side of joint capsuleInconsistently present

Ulna collateral ligamentThickening of joint capsuleExtends from ulna styloid to triquetrum

Sheath of ECU tendon on dorsal Ulna

Meniscus homologueMeniscus homologueThickening on ulnar side of joint capsuleThickening on ulnar side of joint capsuleInconsistently presentInconsistently present

Ulna collateral ligamentUlna collateral ligamentThickening of joint capsuleThickening of joint capsuleExtends from ulna styloid to triquetrumExtends from ulna styloid to triquetrum

Sheath of ECU tendon on dorsal UlnaSheath of ECU tendon on dorsal Ulna

TFCC tear arthrogramTFCC tear arthrogram

Note Lunate and Ulnar cartilage touching

TFCC radial tearTFCC radial tear

TFCC - perforationTFCC - perforation

Perforations may not be clinically significant

Central TFCC TearCentral TFCC Tear

Meniscal homologueMeniscal homologue

Meniscal homologueMeniscal homologue

Peripheral TFCC tear

Ulno-lunate AbutmentUlno-lunate Abutment

-Positive ulnarvariance

-Cystic changein lunate

-TFCC tear

Thank You