Sagittal Sequences
HIDEInteractive Transcript
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.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
© 2024 MRI Online. All Rights Reserved.