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Wrist Ligament Tears: Evaluation of MRI and Combined MDCT and MR Arthrography

¹ All authors: Department of Radiology, CHU Strasbourg, Ave. Molière, Strasbourg, France 67000.

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Phantoms studied in vitro. Schematic shows phantom composition. Phantoms 9-12 consist of 2.5 or 500 (asterisk) mmol/L tetraazacyclododecanetetraacetic acid (DOTA)-gadolinium and 370 mg I/mL iopamidol. Phantoms 1-6 consist of 2.5 or 500 (asterisk) mmol/L DOTA-gadolinium and 300 mg I/mL iopamidol.

View larger version (39K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Phantoms studied in vitro. MDCT arthrographic images.

View larger version (43K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Phantoms studied in vitro. Fat-saturated T1-weighted spin-echo (TR/TE, 717/23) MR arthrographic images.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Phantoms studied in vitro. T1-weighted fast low-angle shot (32/4.7; flip angle, 60°) MR arthrographic images.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —33-year-old man with complete scapholunate ligament tear. Coronal 3D double-echo steady-state (TR/TE, 32.24/7.8; flip angle, 30°) MR image shows wide scapholunate joint space and fluid accumulation (arrow) within ligament substance, which are unequivocal signs of tear.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —33-year-old man with complete scapholunate ligament tear. Midcarpal arthrogram shows radiocarpal communication through scapholunate interval (arrow).

View larger version (203K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —33-year-old man with complete scapholunate ligament tear. Coronal reformation of MDCT arthrogram depicts disrupted volar portion of scapholunate ligament with scaphoid stump (arrow).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —33-year-old man with complete scapholunate ligament tear. Transverse reformation of MDCT arthrogram shows disrupted dorsal (white arrow) and volar (black arrow) portions of scapholunate ligament.

View larger version (194K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —33-year-old man with complete scapholunate ligament tear. Coronal fat-saturated T1-weighted spin-echo (717/23) MR arthrogram shows disrupted volar portion of scapholunate ligament with scaphoid stump (arrow).

View larger version (74K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —33-year-old man with complete scapholunate ligament tear. Transverse T1-weighted 3D fast low-angle shot (32/4.7; flip angle, 60°) MR arthrogram shows disrupted dorsal (white arrow) and volar (black arrow) portions of scapholunate ligament. Because of contrast impregnation, ligament stumps are less conspicuous than in E.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —18-year-old woman with partial tear of lunotriquetral ligament and central perforation of triangular fibrocartilage complex. Coronal T1-weighted spin-echo (TR/TE, 586/23) MR image shows essentially normal lunotriquetral (black arrow) and triangular (white arrow) ligaments.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —18-year-old woman with partial tear of lunotriquetral ligament and central perforation of triangular fibrocartilage complex. Coronal 3D double-echo steady-state (32.24/7.8; flip angle, 30°) MR image shows essentially normal lunotriquetral (black arrow) and triangular (white arrow) ligaments.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —18-year-old woman with partial tear of lunotriquetral ligament and central perforation of triangular fibrocartilage complex. Coronal reformation of MDCT arthrogram (midcarpal injection) shows abnormal communication through lunotriquetral (black arrow) and triangular (white arrow) ligament tears.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —18-year-old woman with partial tear of lunotriquetral ligament and central perforation of triangular fibrocartilage complex. Sagittal reformation of MDCT arthrogram (midcarpal injection) clearly shows central perforation of triangular fibrocartilage (arrow).

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —18-year-old woman with partial tear of lunotriquetral ligament and central perforation of triangular fibrocartilage complex. Coronal fat-saturated T1-weighted spin-echo (717/23) MR arthrogram shows that lunotriquetral (black arrow) and triangular (white arrow) ligament tears are indiscernible.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —54-year-old man with incidental finding of asymptomatic ulnocarpal impingement syndrome. Posteroanterior radiograph shows focal radiolucency of lunate bone (arrow) in front of ulnar head.

View larger version (183K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —54-year-old man with incidental finding of asymptomatic ulnocarpal impingement syndrome. Coronal 3D double-echo steady state (TR/TE, 32.24/7.8; flip angle, 30°) MR image shows cystlike defect of lunate bone (arrow) in front of ulnar head.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —54-year-old man with incidental finding of asymptomatic ulnocarpal impingement syndrome. Coronal reformation of MDCT arthrogram (midcarpal and radiocarpal injections) shows well-demarcated cystlike defect of lunate bone (white arrow) and overlying cartilage thinning (black arrow).

View larger version (197K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —54-year-old man with incidental finding of asymptomatic ulnocarpal impingement syndrome. Coronal fat-saturated T1-weighted spin-echo (717/23) MR arthrogram shows neither cystlike defect of lunate bone (arrow) nor cartilage abnormality.

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