MR imaging of trauma: elbow and wrist

The use of magnetic resonance imaging (MRI) in the setting of acute trauma is increasing due to many factors including availability and demand. The ability to evaluate for occult fractures in addition to concomitant soft tissue injuries has a significant impact on patient management and MRI is the ideal adjunct to plain radiography. Occult fractures in the forearm, particularly the radial head and scaphoid, are common and often lead to repeated examinations and delayed diagnosis, which can be avoided by the use of MRI early in patient investigation. Orthopedists are increasingly performing ligament repairs at the time of fracture fixation and therefore benefit from preoperative MRI to assess the extent of soft tissue injury.     

Magnetic resonance imaging of the wrist

Optimal magnetic resonance (MR) imaging of the wrist requires a high field strength magnet and a dedicated wrist coil to achieve high-resolution images. Using current MR sequences, detailed images of articular cartilage and the supporting ligaments and tendons can be obtained. Evaluation of the triangular fibrocartilage as well as the extrinsic and intrinsic ligaments of the wrist is possible with thin-slice three-dimensional volumetric gradient recalled sequences. Fast inversion recovery sequences, used to achieve fat suppression in peripheral joints such as the wrist, allow for detection of acute osseous trauma, which is often radiographically occult. Cartilage-sensitive imaging allows for evaluation of conditions in the skeletally immature patient, such as chronic physeal loading in the adolescent gymnast, as well as detection of the sequelae of altered biomechanics in the adult, as in the ulnolunate impaction syndrome. Moreover, contrast-enhanced magnetic resonance angiography permits a relatively noninvasive evaluation of peripheral vascular disease, obviating the need for an intraarticular injection.     

Magnetic resonance imaging of the wrist

MR imaging of the wrist has the unique capability of simultaneously demonstrating bone and soft tissue structures. Its exquisite sensitivity for detecting bone marrow edema makes it an ideal screening tool for diagnosing radiographically occult osseous injuries and areas of AVN. This, together with its ability to provide a comprehensive, non-ivasive assessment of the ligaments, tendons, nerves, and components of the TFC make MRI a very powerful tool for evaluating patients with wrist pain of uncertain etiology. Its exact role in the work-up of these patients has not been entirely established, but with further advances in technology and the radiologist's understanding of wrist anatomy and pathology, MRI is assuming a more central role in this clinical setting.     

Magnetic resonance imaging of the elbow

Despite being one of the more commonly injured joints in recreational and elite athletes, diagnosis of soft-tissue injuries of the elbow remains problematic. Although plain radiographs remain the initial mainstay for imaging of the elbow, the superior soft-tissue contrast and direct multiplanar capabilities of magnetic resonance (MR) imaging has afforded the ability to more accurately diagnose the site and extent of soft-tissue pathology, including tendinous injuries and trauma to the static stabilizers. In addition, the ability of MR imaging to noninvasively assess the integrity of the articular cartilage provides for more comprehensive information that was previously unavailable and has prognostic significance in the athlete.     

Magnetic resonance imaging of the elbow

With the current popularity of racket and throwing sports, the number of individuals seeking medical care for elbow pain and dysfunction has increased. Elbow dysfunction may be related to acute or chronic injury to the soft tissue or osseous components of the elbow. With magnetic resonance imaging (MRI), it is now possible to accurately determine the nature and extent of the pathological changes in ligaments, tendons, muscles, and osseous structures of the elbow joint. This information facilitates the choice of the appropriate therapeutic regimen.     

Magnetic resonance imaging of the elbow

Elbow pain is frequently encountered in clinical practice and can result in significant morbidity, particularly in athletes. Magnetic resonance imaging (MRI) is an excellent diagnostic imaging tool for the evaluation of soft tissue and osteochondral pathology around the elbow. Recent advances in magnetic field strength and coil design have lead to improved spatial resolution and superior soft tissue contrast, making it ideal for visualization of complex joint anatomy. This article describes the normal imaging appearances of anatomy around the elbow and reviews commonly occurring ligamentous, myotendinous, neural, and bursal pathology around the elbow. J. Magn. Reson. Imaging 2010;31:1036–1053. © 2010 Wiley‐Liss, Inc.     

Magnetic resonance (MR) imaging of the normal mediastinum

Magnetic Resonance (MR) cross sectional images of the normal mediastinum are presented and discussed. In normal subjects most mediastinal structures visible on Computed Tomography (CT) are also visible using MR. The primary advantages of MR over CT in the evaluation of mediastinum are the greater soft tissues contrast resolution, the multiplanar (axial, coronal and sagittal) display of the mediastinal anatomy and its ability to distinguish vascular from nonvascular structures without injection of contrast media.     

Magnetic resonance imaging of the shoulder

MR imaging has proved to be of great value in the assessment of musculoskeletal imaging. Its superiority in evaluating knee and spine pathology is well established. Recent studies also have established an important role for MR imaging in the assessment of shoulder disorders. Multiplanar capabilities coupled with excellent contrast resolution that allows simultaneous delineation of osseous and soft-tissue structures make MR imaging a useful method for evaluating the complex anatomy of the shoulder.     

Magnetic resonance imaging of the shoulder

Magnetic resonance imaging is rapidly becoming the procedure of choice to evaluate the shoulder. This article reviews the relevant technical, anatomic, and pathologic features important in imaging the joint with magnetic resonance, with an emphasis on rotator cuff disease and shoulder instability.     

Magnetic resonance imaging of the wrist ligaments

The advent of small arthroscopes has enabled the hand surgeon to visualize the ligaments of the wrist directly with resultant increased accuracy in diagnosing and treating pathology. Orthopaedists are now demanding a preoperative assessment and this, in turn, has necessitated that radiologists have a comprehensive understanding of wrist anatomy. High resolution MR imaging can identify the wrist ligaments reliably and provide information concerning their integrity. Interpretation is not straightforward; there is considerable anatomic variation, and there are perforations, defects and degenerative tears that can be troublesome in diagnosing injury. However, with experience and attention to anatomic detail, the radiologist can provide useful information regarding structural abnormalities. When injured, the ligaments of the wrist behave as other joint ligaments do. Findings following injury include discontinuity of normal striated bands, incomplete disruption, irregularities and alteration in normal signal. Fluid pooling around a ligament and concomitant bone injury are other clues to injury. The identification of such structural abnormalities may help to explain altered biomechanics and improve the management of patients following wrist injury.     

Magnetic resonance imaging of thehand and wrist

The application of magnetic resonance imaging (MRI) to the hand and wrist has lagged behind its use in larger joints. Recent advances in hardware and software technology have allowed faster imaging with excellent anatomic resolution. After routine radiography, MRI is the imaging procedure of choice for evaluation of chronic wrist pain. The most common indications for MRI within the hand and wrist include scapholunate-lunate ligament tears, triangular fibrocartilage complex (TFCC) tears, avascular necrosis, and soft tissue masses. MRI may occasionally help evaluate tendon abnormalities, atypical or postoperative recurrent carpal tunnel syndrome, and complications of inflammatory arthritides. Future applications of MRI will likely include improved anatomic imaging of smaller structures such as the lunatotriquetral ligament and the extrinsic ligaments, as well as MR angiography (MRA).     

Magnetic resonance (MR) cine imaging of the human heart

A novel approach has been developed for MR cine imaging of the human heart by a modified ECG-gated 2DFT method. A pulse sequence has been devised to minimise the effects of saturation which can be anticipated in sequences that require rapid pulsing. Five frames are produced at the same anatomical level at predetermined intervals during the cardiac cycle. The total time taken to achieve this data is 8 minutes. Additional frames can be interleaved by repeating the sequence with an ECG-gated delay. The anatomical sections, which can be in any orthogonal plane, are then displayed as a cine loop. Cine display in the coronal plane has been used to examine 10 volunteers and 12 patients. In addition to the morphological feature displayed in single slice ECG-gated imaging, areas of dyskinesia can be detected and subjective estimates have been made of left ventricular function.     

MR imaging: Arthropathies and infectious conditions of the elbow, wrist, and hand

The superior soft tissue contrast and multiplanar capability of MR imaging has contributed to earlier diagnosis and implementation of effective treatment for a variety of arthropathies and infectious conditions of the elbow, wrist, and hand. Because of overlapping clinical signs and symptoms, MR imaging plays an important role in delineating the features and staging of each of these conditions. This article discusses the seropositive and seronegative inflammatory arthropathies, with emphasis on early detection and surveillance, as well as gout, synovial osteochondromatosis, pigmented villonodular synovitis, tenosynovitis, and de Quervain's tenosynovitis. Certain noninflammatory arthritides and infectious conditions are also reviewed.     

Magnetic resonance imaging of the shoulder.

The authors have reviewed the field of magnetic resonance imaging of the shoulder. This review includes abnormalities of the rotator cuff mechanism and glenoid labrum, and other disorders.     

Magnetic resonance imaging of the painful wrist.

This pictorial review illustrates the use of magnetic resonance imaging in the assessment of the painful wrist. Careful technique is essential to optimize the accuracy of MR of the wrist. MR is the investigation of choice in avascular necrosis and has an increasing role in internal derangement, trauma and soft tissue lesions.     

Magnetic resonance imaging of the elbow in athletes

Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.