MRI Wrist — routine
Distal radioulnar joint through the carpus to the proximal metacarpals; extend distally where the question involves the digits.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Clinically suspected scaphoid fracture with normal radiographs.
- Suspected avascular necrosis of the scaphoid proximal pole or lunate.
- Ulnar-sided wrist pain with suspected triangular fibrocartilage injury.
- Suspected scapholunate or lunotriquetral ligament injury.
- Ganglion, tenosynovitis, nerve compression, or early inflammatory arthropathy.
Technique
- Coronal T1 and coronal fluid-sensitive fat-suppressed sequences are the core pair; for suspected occult scaphoid fracture these two alone are usually sufficient and the study can be short.
- Axial and sagittal imaging added for tendons, nerves and carpal alignment.
- Small field of view of the order of 8-10 cm with thin slices; wrist structures demand the highest spatial resolution of any routine joint study.
- Positioning above the head in the isocentre gives better image quality but is poorly tolerated; imaging by the side is more comfortable and costs signal and homogeneity. Centres differ and the choice should be made with the patient.
Where it goes wrong
- Field of view too large, so intrinsic ligaments and the triangular fibrocartilage are not resolved.
- Motion during long high-resolution acquisitions in an uncomfortable position.
- Off-isocentre positioning degrading fat suppression across the wrist.
- Booking a full internal-derangement protocol for a simple occult scaphoid fracture question, which wastes scanner time that the pathway needs to be fast.
- Expecting conventional MRI to exclude a partial intrinsic ligament tear, which is where arthrography retains an advantage.
Clinical questions that reach this study
Contrast
None
- Unenhanced for fracture, avascular necrosis and most soft-tissue questions. Contrast is used for inflammatory arthropathy activity and suspected infection or tumour; intrinsic ligament and triangular fibrocartilage questions escalate to arthrography instead.
Acquisition
- Breathing
- Not applicable; the limiting factor is how long the patient can hold the position.
- Preparation
- Occult scaphoid fracture needs only a short focused protocol; do not book a full internal-derangement study for it. Positioning matters: superman positioning improves resolution but is poorly tolerated, and by-the-side positioning costs image quality. Agree which is realistic before the appointment.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan