0:00

The sagittal sequence, the stepchild,

0:04

the oft-forgotten sequence in MRI of the wrist.

0:08

Should it be forgotten?

0:10

Well, sometimes, to be honest, but it has

0:13

a role and a place, especially when you're

0:17

interested in something that is long.

0:21

What do I mean by long?

0:22

It has length, like tendons.

0:25

If you want to see where a tendon is torn

0:26

and where it's retracted to, nothing beats

0:30

the sagittal projection for that purpose.

0:32

Whether it's a flexor or it's an extensor.

0:36

As far as the sequence goes, I prefer a

0:40

proton density fat-saturated, or fat-suppressed.

0:46

And the reason for that is just pure discovery.

0:50

But if I know I'm looking for ulnar-sided

0:52

wrist pain, and I'm interested in the

0:55

peripheral, as well as the dorsal and volar

0:59

attachments, The triangular fibrocartilage,

1:02

which we'll see later on, is uber complex.

1:06

Then I like to have this sequence

1:08

in the sagittal projection.

1:10

The 3D, 1 millimeter, thin-section,

1:14

gradient echo image for this very purpose.

1:18

Now, another advantage of the sagittal projection

1:21

in general, doesn't matter what sequence

1:23

it is, is it shows you overall alignment.

1:27

The metacarpal, the capitate,

1:29

the lunate, and the radius line up nicely.

1:32

It also does a wonderful job of showing you the

1:36

scaphoid angle, which should be at about 60 degrees.

1:39

Not flopping down, as might

1:42

occur with certain instabilities.

1:44

It shows you the shape, which should be smooth

1:48

without a bump or a hump from prior fractures.

1:52

It probably does the best job of all.

1:55

At looking at the hook of the hamate or hamulus of

1:59

the hamate for subtle fractures and stress injuries.

2:03

Especially in golfers, you know,

2:05

golfing is a full contact sport.

2:07

Especially when it vibrates the

2:09

hypothenar eminence of the hand.

2:12

And it does a great job at showing you the pisotriquetral

2:16

articulation, which is right there.

2:20

It's kind of like the AC joint of the shoulder.

2:23

Nobody has a normal one; this one has a little bit

2:28

of thickening, fluid, or capsulitis in it, but

2:32

rarely are these symptomatic unless you press

2:35

on them and you get symptoms or you see a

2:37

large cyst or edema in these adjacent bones.

2:42

Well, that is my spiel on the sagittal projection.

2:47

Basic, basic.

2:49

Don't ignore it.

2:50

It's a stepchild, but it has a role.

Sagittal Sequences

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0:00

The sagittal sequence, the stepchild,

0:04

the oft-forgotten sequence in MRI of the wrist.

0:08

Should it be forgotten?

0:10

Well, sometimes, to be honest, but it has

0:13

a role and a place, especially when you're

0:17

interested in something that is long.

0:21

What do I mean by long?

0:22

It has length, like tendons.

0:25

If you want to see where a tendon is torn

0:26

and where it's retracted to, nothing beats

0:30

the sagittal projection for that purpose.

0:32

Whether it's a flexor or it's an extensor.

0:36

As far as the sequence goes, I prefer a

0:40

proton density fat-saturated, or fat-suppressed.

0:46

And the reason for that is just pure discovery.

0:50

But if I know I'm looking for ulnar-sided

0:52

wrist pain, and I'm interested in the

0:55

peripheral, as well as the dorsal and volar

0:59

attachments, The triangular fibrocartilage,

1:02

which we'll see later on, is uber complex.

1:06

Then I like to have this sequence

1:08

in the sagittal projection.

1:10

The 3D, 1 millimeter, thin-section,

1:14

gradient echo image for this very purpose.

1:18

Now, another advantage of the sagittal projection

1:21

in general, doesn't matter what sequence

1:23

it is, is it shows you overall alignment.

1:27

The metacarpal, the capitate,

1:29

the lunate, and the radius line up nicely.

1:32

It also does a wonderful job of showing you the

1:36

scaphoid angle, which should be at about 60 degrees.

1:39

Not flopping down, as might

1:42

occur with certain instabilities.

1:44

It shows you the shape, which should be smooth

1:48

without a bump or a hump from prior fractures.

1:52

It probably does the best job of all.

1:55

At looking at the hook of the hamate or hamulus of

1:59

the hamate for subtle fractures and stress injuries.

2:03

Especially in golfers, you know,

2:05

golfing is a full contact sport.

2:07

Especially when it vibrates the

2:09

hypothenar eminence of the hand.

2:12

And it does a great job at showing you the pisotriquetral

2:16

articulation, which is right there.

2:20

It's kind of like the AC joint of the shoulder.

2:23

Nobody has a normal one; this one has a little bit

2:28

of thickening, fluid, or capsulitis in it, but

2:32

rarely are these symptomatic unless you press

2:35

on them and you get symptoms or you see a

2:37

large cyst or edema in these adjacent bones.

2:42

Well, that is my spiel on the sagittal projection.

2:47

Basic, basic.

2:49

Don't ignore it.

2:50

It's a stepchild, but it has a role.

Report

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

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Wrist MRI Mastery Series: Pre-Course Activities

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Wrist MRI Mastery Series: Introduction to Wrist Imaging

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Wrist MRI Mastery Series: Imaging Techniques & Protocols

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Wrist MRI Mastery Series: Anatomy

Lesson

Wrist MRI Mastery Series: Anatomy - Focus on the TFC

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Wrist MRI Mastery Series: Case Review

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Wrist MRI Mastery Series: Surgical Perspective - Case Review

Sagittal Sequences