Multicompartmental Dynamics of the Wrist Joint in Two-Plane Movement Using Clinically Applicable Fast Cine MRI Sequences in Healthy Volunteers: Technique and Reader Reliability

Purpose or Learning Objective: To study kinematic magnetic resonance imaging (MRI) of the wrist in asymptomatic volunteers and assess the pattern of movement in the proximal and distal carpal rows with special attention to the midcarpal joint during uninterrupted radial, ulnar deviation, dorsal, and palmar maneuvers.

Methods or Background: A total of 19 asymptomatic volunteers 18 to 55 years of age participated in the study. Six of them had both wrists imaged; 13 had the dominant hand imaged. Five measurements were obtained: neutral, maximal radial, and ulnar deviation in the coronal and the sagittal planes.

Volunteers were imaged in a 3-T magnet (Siemens Lumina, Erlangen, Germany), in the head-first prone (so-called superman) position. Volunteers moved their wrist in continuous radial to ulnar and dorsopalmar deviation during acquisition, achieving maximum range.

A dynamic MRI pulse sequence was used in a multislice two-dimensional radially acquired fast-gradient echo sequence with water excitation, known as fast low angle shot MRI (FLASH) (field of view, 120 mm²; matrix size, 112 × 112; number of radial spokes, 192; TR/TE, 44.3/3.50 ms; bandwidth, 446 Hz/pixel; flip angle, 12 degrees) for 42 seconds.

Results or Findings: The trapezium moved most in radial deviation with a mean translation of 5.2 mm between the radial and ulnar deviation. A greater degree of trapezial translation was observed in the neutral position (1.42 mm) with type I lunate compared with type II: − 1.11 mm (p value, − 01). Greater trapezial translation in the left wrist (1.58 mm) was observed in the neutral position compared with the right wrist: 1.18 mm (p value, − 0.01).

Mean capitate-triquetrum distance was greater in radial deviation: 2.46 mm (p value = − 0.003). Also men had greater capitate-triquetrum distance (4.5 mm) values compared with women (3.81 mm) in the neutral position (p value, − 0.05). Greater mean capitate-triquetrum distance was seen in the cohort with type II lunate in the neutral (p, − 0.001) position.

The scapholunate interval was observed more in the radial deviation, as well as an increased lunotriquetral interval. The capitolunate angle had a greater degree of inclination in the palmar motion.

A significant variation between the dominant and nondominant wrist was observed during palmar flexion in the right hand (p value, − 0.03).

Conclusion: This pilot study of multicompartmental dynamics of the wrist joint in two-plane movement used fast cine MRI sequences and defined the normal metrics of clinically significant intercarpal spaces. The normal metrics obtained could help clinically to define set values beyond which carpal instability can be accurately diagnosed and to take prophylactic measures in people with borderline metrics.

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Artikel online veröffentlicht:
02. Juni 2022