MRI of the Wrist

Marcos Loreto Sampaio, MD; Nicholas M. Kolanko, MD


Appl Radiol. 2014;43(10) 

In This Article


Radiography is the primary modality used to diagnose and stage arthritis of the hands and wrist. Osteoarthritis may incidentally be seen on MRI as areas of chondropathy, bone-marrow edema, cysts, and sclerosis, as well as areas of osteophyte formation, joint effusion and synovial reaction. Internal derangements such as SLL or TFC tears may be associated. Large field-of-view MRI of the hands is employed in many centers to investigate and stage cases of inflammatory arthropathies such as rheumatoid and psoriatic arthritis. Findings include synovitis and marrow edema, bone erosions, periarticular cysts and tenosynovitis (Figure 17).[32] Investigating inflammatory arthropathies warrants the use of intravenous gadolinium.[33] Acute and subacute carpal infections and tenosynovitis are characterized by synovitis and erosions, as well as by capsular and soft-tissue edema in variable degrees, and also warrant the use of IV contrast (Figure 18).

Figure 17.

Rheumatoid arthritis. Coronal T2-weighted image with fat suppression. Diffuse deep chondral erosions of the proximal and midcarpal compartments and large joint effusion with synovitis (*) were found during the investigation of chronic wrist pain in this 35-year-old woman. Erosions are seen in the scaphoid and triquetrum (arrows).

Figure 18.

Septic arthritis. Axial T2-weighted image with fat suppression reveals a joint effusion with synovitis, capsular and peri-articular edema with phlegmonous changes, particularly dorsally.