(iii) Imaging of the wrist —a customized approach

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

“…Since treatment methods change depending on their size and location, preoperative imaging is crucial for making the diagnosis [1,3,5]. Besides the well-known soft tissue contrast capabilities and favourable results of conventional MR imaging, there are still difficulties in imaging these ligament lesions particularly on low-and midfield-strength MR systems.…”

“…Ligamentous injuries of the wrist and carpal region have been cited as the most complex and laborious problems of the wrist [1,2]. Documentation or exclusion of even minor abnormalities of intra-articular and periarticular structures is essential for appropriate clinical management [2,3].…”

“…Documentation or exclusion of even minor abnormalities of intra-articular and periarticular structures is essential for appropriate clinical management [2,3]. Especially the assessment of the proximal intercarpal ligaments [scapholunate (SL), lunatotriquetral (LT) and triangular fibrocartilage complex (TFCC)], which play an important role for normal wrist function and stability, is crucial [1,4]. The purpose of this study was to compare the diagnostic value of conventional MR imaging and MR arthrography in the detection of intra-articular ligament injuries and to give the preliminary results of cine-MR arthrography as a new technique.…”

Wrist Instability

“…Although the use of conventional PA and lateral radiographs is widely adopted, the value of additional views is questionable and debated in the literature and among clinicians. Several additional views (instability series and/or stress views) are described; PA views with maximal ulnar and maximal radial deviation, and AP clenched fist views are among the ones most commonly used (Gilula et al 2002;Peh and Gilula 1994;Weiss et al 2007;De Filippo et al 2006;Metz et al 1997;Pliefke et al 2008). In some cases up to 15 different additional views to analyze the wrist of a single patient are described (Metz et al 1997).…”

“…It is recommended that both wrists are imaged enabling comparison; this can only be done if standardized techniques are used. Although this standardized technique is well described in the literature (Gilula et al 2002;Peh and Gilula 1994;Weiss et al 2007), awareness of such standardization among radiographers and clinicians is often lacking. Training of radiology technicians and radiographers in how to achieve optimal and reproducible images should be part of the clinical responsibility of the supervising radiologist.…”