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Internal Derangement of the Wrist: Indirect MR Arthrography versus Unenhanced MR Imaging¹

¹ From the Department of Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042 (A.H.H., R.C.L.); and Departments of Radiology (M.E.S., W.B.M., D.D.) and Orthopedic Surgery (A.L.O., J.M.B., J.S.T., R.W.C.), Thomas Jefferson University Hospital, Philadelphia, Pa. From the 2000 RSNA scientific assembly. Received April 4, 2002; revision requested June 12; final revision received October 28; accepted October 31. Address correspondence to (e-mail: andrew.haims@yale.edu).

View larger version (151K): [in a new window]   Figure 1a. Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).

View larger version (143K): [in a new window]   Figure 1b. Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).

View larger version (132K): [in a new window]   Figure 2a. Images in two different patients with normal scapholunate ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the scapholunate ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows).

View larger version (148K): [in a new window]   Figure 2b. Images in two different patients with normal scapholunate ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the scapholunate ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows).

View larger version (130K): [in a new window]   Figure 3a. Images in two different patients with normal lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 41-year-old man illustrates a normal low-signal-intensity appearance of the lunotriquetral ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low signal intensity of the lunotriquetral ligament (arrows).

View larger version (140K): [in a new window]   Figure 3b. Images in two different patients with normal lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 41-year-old man illustrates a normal low-signal-intensity appearance of the lunotriquetral ligament (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 21-year-old woman demonstrates a normal low signal intensity of the lunotriquetral ligament (arrows).

View larger version (152K): [in a new window]   Figure 4a. Images in two different patients with tears of the central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the ulnar side of the lunate, which is consistent with ulnar impaction syndrome. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows).

View larger version (137K): [in a new window]   Figure 4b. Images in two different patients with tears of the central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the ulnar side of the lunate, which is consistent with ulnar impaction syndrome. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows).

View larger version (135K): [in a new window]   Figure 5a. Images in two different patients with torn scapholunate ligaments. (a) Coronal T1-weighted fat-suppressed indirect MR arthrogram (500/14) in a 53-year-old woman demonstrates fluid signal intensity (arrows) between the scaphoid and the lunate. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the scapholunate ligament (arrows).

View larger version (143K): [in a new window]   Figure 5b. Images in two different patients with torn scapholunate ligaments. (a) Coronal T1-weighted fat-suppressed indirect MR arthrogram (500/14) in a 53-year-old woman demonstrates fluid signal intensity (arrows) between the scaphoid and the lunate. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the scapholunate ligament (arrows).

View larger version (144K): [in a new window]   Figure 6a. Images in two different patients with torn lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 33-year-old man illustrates abnormal high signal intensity (arrows) through the region of the lunotriquetral ligament. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity in the region of the lunotriquetral ligament (arrows).

View larger version (152K): [in a new window]   Figure 6b. Images in two different patients with torn lunotriquetral ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45° flip angle) in a 33-year-old man illustrates abnormal high signal intensity (arrows) through the region of the lunotriquetral ligament. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10° flip angle) in a 46-year-old man demonstrates abnormal high signal intensity in the region of the lunotriquetral ligament (arrows).