This document provides information about MRI protocols for imaging the hand and wrist. It outlines indications for MRI including marrow abnormalities, infections, and ligament tears. It describes patient preparation including removal of metal objects and use of ear protection. Imaging sequences are listed including T1, T2, STIR sequences in axial, coronal and sagittal planes. Positioning involves placing the hand in a coil with the arm up or prone. Common artifacts and examples of pathology detected on MRI such as fractures and arthritis are also discussed.

2. INDICATIONS
• Marrow abnormalities (bone contusions, osteonecrosis,
marrow edema syndromes, stress fracture).
• Synovial based disorders.
• Infections of bone, joint or soft tissues.
• Carpal tunnel syndrome.
• Avascular necrosis.
• Soft tissues masses.
• Occult fracture.
• Ganglion cyst.
• Ligaments tear.

3. CONTRAINDICATION
• Intracranial aneurysm clips (unless made of
titanium).
• Pregnancy.
• Ferromagnetic surgical clips or staples.
• Metallic foreign body in eye.
• Metal shrapnel or bullet.
• Magnetically or mechanically implant(cardiac
pacemaker, insulin pump biostimulator).

4. EQUIPMENTS
• Strap.
• Sponge.
• Cushion.
• Small phase array coil.
• Wrist coil 8 elements.
• Hand/Wrist coil 4 elements.

5. PATIENT PREPARATION
1) Consent form be taken from the patient before entering
the scanner room.
2) Ask the patient to remove all metal objects include
keys, coins, wallet, cards with cips, jewellery hearing
and hair pins.
3) Claustrophobic patients may accompanied into scanner
room by staff member or relative with proper safety
screening.
4) Explain the procedure to the patient.
5) Offer earphones for communicating with the patient
and ear protection.
6) Note the weight of patient.

6. PATIENT POSITIONING
1) Head first prone position with arm up like
(superman/ swimmer’s position).
2) Position the wrist in small flex coil and
immobilization with cushions.

7. PATIENT POSITIONING
• Place the cushions under the chest for extra
comfort.
• Center the laser beam localizer over the wrist
joint.
• Then register the patient in scanner as head first
supine.

8. SEQUENCES

9. SEQUENCES
Plan the axial slices on the coronal plane.
Plan the coronal slice on the axial plane.
Plan the sagittal slices on the axial plane.
Angle the position block:
 AXIAL:
Perpendicular to wrist joint (across carpal bones).
 CORONAL:
Parallel to anterior radial metaphysis at distal radioulnar
joint.
 SAGITTAL:
Perpendicular to anterior radial metaphysis at distal
radioulnar joint.

10. SEQUENCES
Slice cover whole wrist from:
Axial: cover slice from above carpometacarpal
joint up to three slice below distal radioulnar joint.
Coronal: cover slice from dorsal to palmar.
Sagittal: cover slice from medial to lateral.
Applying saturation band above and below area of
radial and ulnar artery pulsation artifacts.

11. LOCALIZERS
Axial

12. LOCALIZERS
Coronal
Sagittal

13. SEQUENCES
SEQUENCES TR TE SLICE MATRIX FOV GAP
T2*Axial 3mm 800-1200 15-25 3mm 256x256 100-110 10%
T2 STIR Coronal 3000-4000 110 3mm 256x256 110-120 10%
T1 TSE Coronal 400-600 15-25 3mm 320x256 110-120 10%
T2*Coronal 800-1200 15-25 3mm 256x256 100-110 10%
T2 STIR sagittal 3000-4000 110 3mm 256x256 110-120 10%

14. T2* AXIAL T2*CORONAL
T2 STIR CORONALT1 TSE CORONALT2 STIR SAGITTAL

15. MRI HAND

16. INDICATION:
• Atherosclerotic disease.
• Artery stenosis.
• Thrombotic and embolic
disease.
• Artery dissections.
• Anuerysm.
CONTRAINDICATION:
• Metallic foreign body in
eye.
• Feromagnetic surgical
clips or staples
• Pregnancy
• Metal sharpnel or bullet

17. Patient preparation
• Consent form be taken from the patient before
entering the scannner room.
• Ask the patient to remove all metal objects
include keys,coins, wallet, cards with cips,
jewellery hearing and hair pins.
• Claustrophobic patients may accompanied into
scanner room by staff member or relative with
proper safety screening.
• Explain the procedure to the patient.

18. Patient preparation
• Contrast injection risk and benefit be explained to
the patient before the scan.
• Gadolinium only be given to the patient.
• Intravenous line (iv line) placed with extension
tubing extending out magnetic bore.
• Offer earphones for communicating with the patient
and ear protection.
• Note down the weight of patient.

19. Patient positioning
• Head first prone with arm up
• Position the hand in large flex coil and immobilization
with cushion.
• Give cushion under the chest for extra comfort.
• Center laser beam localiser over metacarpophalangeal
joint.

20. SEQUENCES

21. SEQUENCES
Plan the axial slices on the coronal plane.
Plan the coronal slice on the axial plane.
Plan the sagittal slices on the axial plane.
Angle the position block:
 AXIAL: Perpendicular to metacarpal and phalangeal
bones.
 CORONAL: Parallel to the line across the metacarpal
bones.
 SAGITTAL: Perpendicular to line across metacarpal
bones.

22. SEQUENCES
Slice cover whole hand from:
• AXIAL:
Cover from tip of fingers to line of distal radioulnar
joint.
• CORONAL:
Cover from dorsal to palmar.
• SAGITTAL:
Cover from medial to lateral.

23. LOCALIZERS
AXIAL

24. LOCALIZERS
CORONAL
SAGITTAL

25. SEQUENCES
SEQUENCES TR TE SLICE MATRIX FOV GAP
T2 STIR Axial 3000-4000 110 3mm 320x256 150-180 10%
T1 TSE Axial 400-600 15-25 3mm 320X320 150-180 10%
T1 TSE Coronal 400-600 15-25 3mm 320x320 170-190 10%
T2 STIR Coronal 3000-4000 110 3mm 320X320 170-190 10%
T2 STIR sagittal 3000-4000 110 3mm 320X320 170-190 10%

26. SEQUENCES
T2 STIR AXIAL T1 TSE AXIAL

27. SEQUENCES
T1 TSE CORONAL T2 STIR CORONAL T2 STIR SAGITTAL

28. ARTIFACTS
• Motion artifacts.
• Partial volume artifacts.
• Pulsation artifacts.

29. PATHOLOGY
Axial T2 fatsat image
shows mass to be homogeneous
fluid signal intensity.
Axial T1 image
reveals a smoothly marginated
mass (red arrows) deep to the
ECRL and ECRB tendons.

30. PATHOLOGY
Occult fracture.
• Coronal T1-weighted image
demonstrates a band of low
signal intensity along the
scaphoid.
Avascular necrosis of the
scaphoid.
• Coronal T1-weighted image.

31. PATHOLOGY
Peripheral tear of the TFCC.
• Coronal PD-weighted image
with fat suppression
Rheumatoid arthritis.
• Coronal T2-weighted image
with fat suppression.

32. REFERENCES
• https://mrimaster.com
• http://www.qmed.com
• http://www.wjnm.org/article
• http://www.houstonmethodist.org