Why does the wrist need such a small field of view?

The TFCC and the intrinsic carpal ligaments are only millimetres across. A small FOV with a high matrix and a dedicated coil provides the spatial resolution needed to see a tear that a routine, larger acquisition would blur away.

Why plan the coronal along the intercarpal joint line?

Angling parallel to the curved line connecting the proximal and distal carpal rows profiles the intrinsic ligaments and the TFCC in their optimal plane, so a tear traversing the fibrocartilage is shown clearly.

Why is a 3D GRE sequence used for the wrist?

It acquires a thin isotropic volume that can be reformatted in any plane. That is ideal for the complex three-dimensional shape of the TFCC and for detecting the small chondral lesions that flat 2D slices can miss.

Resources/Protocols

Wrist (TFCC & ligaments)

A dense cluster of tiny structures where resolution is everything. You are assessing the triangular fibrocartilage complex and the intrinsic carpal ligaments — millimetre-scale targets that demand a small field of view and a dedicated coil.

Protocols/Musculoskeletal

When this study is used

Ulnar-sided wrist pain or suspected TFCC tear.
Scapholunate or lunotriquetral ligament injury.
Occult fracture, avascular necrosis (Kienböck's) or a soft-tissue mass.

Patient & coil positioning

Dedicated wrist coil; patient's arm by the side or overhead ('superman') for isocentre, whichever the patient tolerates still.
Wrist neutral, centred on the lunate (the carpal 'keystone'); pad and strap against motion.
Small FOV and high matrix — these structures are only millimetres across.

Localizer

Three-plane localizer covering distal radius/ulna to the metacarpal bases.

Sequence planning

Each sequence below lists how the slice group is positioned — the reference line it follows, its coverage, and why it earns its place in the protocol. Plan against the localizer, not by eye.

Coronal PD & PD fat-sat

Coronal

Planning — Parallel to a line connecting the proximal and distal carpal rows (the intercarpal joint line). Distal radioulnar joint to the carpometacarpal joints.

Why — The TFCC and intrinsic ligaments; a tear reads as high signal traversing the dark fibrocartilage.

Coronal 3D GRE (isotropic)

3D / reformatted

Planning — Thin isotropic volume, reformatted in any plane.

Why — The complex 3D TFCC and small chondral lesions in true cross-section.

Axial PD fat-sat

Axial

Planning — Through the carpal tunnel.

Why — Flexor/extensor tendons and carpal-tunnel structures.

Sagittal T2/PD

Sagittal

Planning — Through the carpal alignment.

Why — Carpal instability and alignment.

Representative parameters

Ranges, not commandments — field strength, coil and vendor move the numbers. What must not move is understanding why each sits where it does.

Sequence	Matrix / FOV	Notes
Coronal PD FS	384 / 8–10 cm	TFCC and intrinsic ligaments
3D GRE	isotropic 0.5 mm	Reformattable; chondral detail
Axial PD FS	320 / 8–10 cm	Carpal tunnel, tendons

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
Poor fat-sat	Wrist off isocentre in the bore	Superman position; STIR or Dixon; re-shim
Low resolution	FOV too large for tiny structures	Small FOV, high matrix, dedicated coil
Motion blur	Long high-res acquisition	Firm strapping; parallel imaging
Magic angle	Curved tendon at 55°	Compare on T2 (long TE)

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
TFCC tear	Coronal PD FS / 3D GRE	High signal within or crossing the dark ulnar-sided fibrocartilage
Scapholunate tear	Coronal PD FS	Disrupted or high-signal ligament with widened interval
Kienböck's (lunate AVN)	Coronal T1	Dark lunate marrow signal

Review checklist

Small FOV and high matrix for the fine structures.
Coronal aligned to the intercarpal joint line.
3D GRE acquired for the TFCC and cartilage.
Fat suppression uniform (or STIR used) at the wrist's off-centre position.

Mistakes that cost repeats

FOV too large, blurring the TFCC and ligaments.
Wrist off isocentre, so spectral fat-sat fails.
Motion over the long high-resolution scan.
Calling a magic-angle tendon abnormal without checking T2.

Common questions

Why does the wrist need such a small field of view?: The TFCC and the intrinsic carpal ligaments are only millimetres across. A small FOV with a high matrix and a dedicated coil provides the spatial resolution needed to see a tear that a routine, larger acquisition would blur away.
Why plan the coronal along the intercarpal joint line?: Angling parallel to the curved line connecting the proximal and distal carpal rows profiles the intrinsic ligaments and the TFCC in their optimal plane, so a tear traversing the fibrocartilage is shown clearly.
Why is a 3D GRE sequence used for the wrist?: It acquires a thin isotropic volume that can be reformatted in any plane. That is ideal for the complex three-dimensional shape of the TFCC and for detecting the small chondral lesions that flat 2D slices can miss.

Try it in ScanFlo: Plan a coronal along the intercarpal joint line, then a straight coronal, and compare the TFCC. The angled plane shows the fibrocartilage cleanly; the straight one cuts it obliquely — which is how a tear gets missed.

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