Magnetic resonance imaging (MRI) is an excellent imaging modality for the evaluation of pathologic processes of the hand and wrist. MRI of the hand and wrist provides high-resolution imaging of osseous structures and soft-tissue structures (including ligaments, tendons, nerves, and muscles) through the use of multiple imaging techniques and pulse sequences. This article updates orthopaedic surgeons on current MRI techniques and illustrates the spectrum of hand and wrist disease detectable by MRI. We searched PubMed with use of the keywords “MRI” plus “hand” or “wrist” for studies less than five years old evaluating MRI techniques. On the basis of a review of the recently published literature and the authors’ experience, we define and describe the applications of the following: (1) conventional, non-gadolinium-enhanced MRI, (2) gadolinium-enhanced MRI, and (3) MR arthrography. We also describe the classic MRI appearance of lesions commonly evaluated by MRI, including occult fracture, triangular fibrocartilage complex injury, interosseous ligament injury, extrinsic carpal ligament injury, thumb ulnar collateral ligament injury, traumatic tendon injury, finger pulley injury, ulnar impaction syndrome, tendinopathy, Kienbock disease, posttraumatic scaphoid osteonecrosis, infection, inflammatory arthropathy, compression neuropathy, and various soft-tissue masses. The incorporation of dedicated surface coils and higher-strength magnets has improved the quality of magnetic resonance imaging (MRI) scanners substantially over the last decade. By manipulating the scanning parameters when performing an MRI examination, contrast differences between tissues can be emphasized on the basis of inherent tissue properties known as T1 and T2. T1-weighted images are generally regarded as best for illustrating anatomic detail. T2-weighted sequences highlight alterations in water content, which are characteristic of most pathologic conditions. Short tau inversion recovery (STIR) and fat-suppressed T2-weighted images accentuate fluid and edema and are the most sensitive for detecting pathologic changes in both bone and soft tissue. The intravenous administration of a gadolinium-based contrast agent …
Read full abstract