Sagittal Sequences
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The sagittal sequence, the stepchild,
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the oft-forgotten sequence in MRI of the wrist.
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Should it be forgotten?
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Well, sometimes, to be honest, but it has
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a role and a place, especially when you're
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interested in something that is long.
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What do I mean by long?
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It has length, like tendons.
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If you want to see where a tendon is torn
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and where it's retracted to, nothing beats
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the sagittal projection for that purpose.
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Whether it's a flexor or it's an extensor.
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As far as the sequence goes, I prefer a
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proton density fat-saturated, or fat-suppressed.
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And the reason for that is just pure discovery.
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But if I know I'm looking for ulnar-sided
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wrist pain, and I'm interested in the
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peripheral, as well as the dorsal and volar
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attachments, The triangular fibrocartilage,
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which we'll see later on, is uber complex.
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Then I like to have this sequence
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in the sagittal projection.
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The 3D, 1 millimeter, thin-section,
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gradient echo image for this very purpose.
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Now, another advantage of the sagittal projection
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in general, doesn't matter what sequence
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it is, is it shows you overall alignment.
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The metacarpal, the capitate,
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the lunate, and the radius line up nicely.
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It also does a wonderful job of showing you the
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scaphoid angle, which should be at about 60 degrees.
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Not flopping down, as might
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occur with certain instabilities.
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It shows you the shape, which should be smooth
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without a bump or a hump from prior fractures.
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It probably does the best job of all.
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At looking at the hook of the hamate or hamulus of
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the hamate for subtle fractures and stress injuries.
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Especially in golfers, you know,
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golfing is a full contact sport.
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Especially when it vibrates the
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hypothenar eminence of the hand.
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And it does a great job at showing you the pisotriquetral
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articulation, which is right there.
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It's kind of like the AC joint of the shoulder.
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Nobody has a normal one; this one has a little bit
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of thickening, fluid, or capsulitis in it, but
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rarely are these symptomatic unless you press
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on them and you get symptoms or you see a
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large cyst or edema in these adjacent bones.
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Well, that is my spiel on the sagittal projection.
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Basic, basic.
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Don't ignore it.
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It's a stepchild, but it has a role.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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