ESSR Suggested Planes

ESSR S



Use of Each Plane

Axial:

  • Carpal tunnel
  • Guyon’s canal
  • Flexor tendons
  • Extensor tendons
  • Ganglion cysts
  • Pulleys
  • Scapholunate & Lunotriquetral ligaments

 

 

121

 

122

Coronal:

  • Scaphoid injury.
  • Joint/synovium assessment.
  • TFCC.
  • Interosseous ligaments (SLL, LTL).
  • DRUJ.
  • FPL.
  • Collateral ligaments

 

120

Sagittal:

  • Carpal articulations
  • Rheumatoid erosions
  • Flexor tendons – Bow stringing
  • Ganglion cysts
  • Joint/synovium assessment

 

124 frieta                123 MSK orthopaedic mri

Use of Each Sequence

SEQUENCES

USES:

 

T1W 

Anatomical Details

Fractures

Marrow pattern

AVN

T1W (Post Contrast - Fat Suppressed)

Synovium in arthritis.

Enhancement in tumours.

Gout Tophi

 

PD/ T2W Fat suppressed/ STIR

Anatomical details

Cartilage assessment

Soft tissue/ marrow oedema

 

T2* weighted (coronal volume sequences)

 

TFCC/ Collateral ligaments

Arthrograms

Loose Bodies.

OCD.

Deep ligamentous/ TFCC tears.

Checklist

Bone

Soft Tissues
  • Scaphoid fracture
  • Other carpal fractures
  • Lunate/peri lunate dislocation
  • Osteomyelitis
  • Mets
  • Haemangioma
  • Enchondroma
  • Mets
  • Kienbock’s disease
  • Hyperparathyroidism Melorrheostosis

 
  • Carpal tunnel
  • Tenosynovitis
  • Ligamentous/Tendon avulsion
  • Ganglion cysts
  • TFCC
  • Tendon avulsions
  • Stener lesion
  • Glomus tumour of nail
  • GCT of tendon sheath
  • Paronychia

 

Wrist joint

Nerves
  • OA
  • Rheumatoid Arthritis
  • Ganglion cysts
  • Septic arthritis      
  • Psoriatic arthritis
  • Gout
  • PVNS
  • Synovial Osteochondromatosis.
  • Loose Bodies
  • Joint effusion

 
  • Median nerve compression
  • Ulnar nerve entrapment
  • Denervation injuries

 

 

 

 

 

 

 

Standard Reports

 

D. STANDARD REPORTS

 

 

MRI OF THE HAND

  • Normal carpal bones.
  • Normal interphalangeal and metacarpophalangeal joints with preserved alignment
  • No evidence of osteoarthritic changes.
  • Intact wrist joint.
  • Intact triangular fibrocartilage.
  • No flexor or extensor tenosynovitis.
  • Normal juxta-articular muscles.
  • No focal marrow lesion.

 

CONCLUSION:

Unremarkable MRI of the hand.

 

MRI OF THE WRIST

  • Intact juxta articular tendons and ligaments.
  • There is no fracture or dislocation.
  • Normal radiocarpal, ulnocarpal, midcarpal and carpometacarpal joints.
  • Normal carpal bones with preserved alignment and intact interosseous ligaments.
  • No flexor or extensor tenosynovitis. No evidence of ganglion cyst. There is no focal bony lesion.
  • Unremarkable carpal tunnel structures.
  • Normal triangular fibrocartilage complex with no focal TFC tear.

 

CONCLUSION

Normal MRI of the wrist.

Applied Radiology Algorithms

 

E. ALGORITHMS

 

 

Scaphoid fracture:

Is there fracture?

Is there AVN of proximal pole?

Is there fragmentation?

Is there lack of enhancement?

 

Thumb ligament injury?

            Is it ulnar collateral ligament injury?

            Is there stener lesion?

            Is the anterior oblique ligament of the first CMC intact?

 

Carpal Tunnel Syndrome:

            Cause?  Lipoma; Nerve sheath tumour, Ganglion cyst

            Effect: Denervation?