MRI of the Wrist:

TFCC and Ligaments

Garry E. Gold, M.D.

Associate Professor of Radiology
Stanford University
 MRI Protocol
zz 88-10
-10 cm
cm FOV
FOV
zz Dedicated
Dedicated wrist
wrist coil
coil
zz 22-3
-3 mm
mm slices
slices
zz 288
288 xx 192
192 matrix;
matrix; paired
paired T1
T1 and
and T2T2--
weighted
weighted images
images
zz Thin
Thin slice
slice 3D
3D for
for TFCC
TFCC andand ligaments
ligaments
zz Superman
Superman position
position better
better for
for imaging
imaging
but
but worse
worse forfor motion
motion
zz Hand
Hand byby side:
side: STIR
STIR oror IDEAL
IDEAL forfor fat
fat sat
sat
Routine MRI wrist:
-Tendon pathology
MRI Protocol
-Carpal tunnel syndrome
-Ganglion cyst
-Acute trauma
-Osteoarthritis
-AVN
MRI wrist with IV contrast:
-Mass
-Infection
-Inflammatory arthropathy
MR arthrogram:
-Ligament tear
 3.0T Protocol

Coronal T1 Coronal T2

2 mm slices, 288x192 matrix, 8 cm FOV

8-channel phased array coil
New Sequence:
3D FSE Cube
3D FSE CUBE Wrist at 1.5T

Coronal Reformat Sagittal Source

0.5 mm isotropic resolution

 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 Wrist
zz Scapholunate
Scapholunate Ligament
Ligament
zzVolar,
Volar, central,
central, dorsal
dorsal (most
(most important)
important)
zzCentral
Central may
may have
have asymptomatic
asymptomatic
perforation
perforation
zzTears
Tears lead
lead to
to dorsal
dorsal intercalated
intercalated
segmental
segmental instability
instability (DISI)
(DISI)
zz Lunotriquetral
Lunotriquetral Ligament
Ligament
zzSmaller
Smaller
zzTears
Tears lead
lead to
to volar
volar intercalated
intercalated
segmental
segmental instability
instability (VISI)
(VISI)
Intercarpal 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

zz Located
Located inin unlar -carpal space
unlar-carpal space
zz Attaches
Attaches toto the
the fovea
fovea at
at the
the base
base ofof the
the
ulnar
ulnar styloid
styloid process
process
zz Attaches
Attaches toto the
the ulnar
ulnar aspect
aspect of
of the
the
lunate
lunate fosse
fosse ofof the
the radius
radius
zz Hyaline
Hyaline cartilage
cartilage interposed
interposed between
between
the
the TFCC
TFCC andand radius
radius
 TFC Continued
zz Meniscus
Meniscus homologue
homologue
zzThickening
Thickening onon ulnar
ulnar side
side of
of joint
joint capsule
capsule
zzInconsistently
Inconsistently present
present
zz Ulna
Ulna collateral
collateral ligament
ligament
zzThickening
Thickening ofof joint
joint capsule
capsule
zzExtends
Extends from
from ulna
ulna styloid
styloid to
to triquetrum
triquetrum
zz Sheath
Sheath of
of ECU
ECU tendon
tendon on on dorsal
dorsal Ulna
Ulna
 TFCC tear arthrogram

Note
Lunate
and Ulnar
cartilage
touching
TFCC radial tear
 TFCC - perforation

Perforations may not be clinically significant

Central TFCC Tear
Meniscal homologue
Meniscal homologue
Peripheral TFCC tear
Ulno-lunate Abutment
-Positive ulnar
variance

-Cystic change
in lunate

-TFCC tear
Thank You