TFCC and Ligaments MRI of the Wrist: TFCC and Ligaments

MRI of the Wrist:
TFCC and Ligaments
Garry E. Gold, M.D.
Associate Professor of Radiology
Stanford University
MRI Protocol
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88-10
-10 cm
cm FOV
FOV
Dedicated
Dedicated wrist
wrist coil
coil
22-3
-3 mm
mm slices
slices
288
288 xx 192
192 matrix;
matrix; paired
paired T1
T1 and
and T2
T2-weighted
weighted images
images
Thin
Thin slice
slice 3D
3D for
for TFCC
TFCC and
and ligaments
ligaments
““Superman”
Superman” position
position better
better for
for imaging
imaging
but
but worse
worse for
for motion
motion
Hand
Hand by
by side:
side: STIR
STIR or
or IDEAL
IDEAL for
for 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
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Scapholunate
Scapholunate Ligament
Ligament
Volar,
Volar, central,
central, dorsal
dorsal (most
(most important)
important)
Central
Central may
may have
have asymptomatic
asymptomatic
perforation
perforation
Tears
Tears lead
lead to
to dorsal
dorsal intercalated
intercalated
segmental
segmental instability
instability (DISI)
(DISI)
Lunotriquetral
Lunotriquetral Ligament
Ligament
Smaller
Smaller
Tears
Tears lead
lead to
to volar
volar intercalated
intercalated
segmental
segmental instability
instability (VISI)
(VISI)
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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
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Located
-carpal space
Located in
in unlar
unlar-carpal
space
Attaches
Attaches to
to the
the fovea
fovea at
at the
the base
base of
of the
the
ulnar
ulnar styloid
styloid process
process
Attaches
Attaches to
to the
the ulnar
ulnar aspect
aspect of
of the
the
lunate
lunate fosse
fosse of
of the
the radius
radius
Hyaline
Hyaline cartilage
cartilage interposed
interposed between
between
the
the TFCC
TFCC and
and radius
radius
TFC Continued
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Meniscus
Meniscus homologue
homologue
Thickening
Thickening on
on ulnar
ulnar side
side of
of joint
joint capsule
capsule
Inconsistently
Inconsistently present
present
Ulna
Ulna collateral
collateral ligament
ligament
Thickening
Thickening of
of joint
joint capsule
capsule
Extends
Extends from
from ulna
ulna styloid
styloid to
to triquetrum
triquetrum
Sheath
Sheath of
of ECU
ECU tendon
tendon on
on dorsal
dorsal Ulna
Ulna
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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