New Perspectives in Imaging of the Wrist and Hand

Imaging of the wrist and hand has dramatically changed in the last few years, thanks to the growing development of new techniques, such as tractography or relaxometry but also to an ever-increasing need from our clinician colleagues. The recent rise of powerful but expensive anti-inflammatory drugs (anti-tumor necrosis factor-α drugs) that can stop the progression of severe chronic diseases such as rheumatoid arthritis has altered the role of imaging. In most countries, rheumatologists now manage rheumatoid arthritis. An accurate and early diagnosis of multifocal synovitis is of crucial importance, and joints of the hand and wrist are obvious targets. Catherine Cyteval’s article compares the accuracy of both dynamic magnetic resonance imaging (MRI) and power Doppler ultrasonography in the detection and quantification of such synovitis. Monitoring treatment efficiency requires a reproducible imaging modality that is sensitive to drug-induced modifications. Will high-field MRI play a role in these clinical situations? The articles by Nadja Saupe and Klaus Friedrich et al discuss the potential impact on wrist imaging at 3 and 7T, respectively. Although imaging of interosseous ligaments appears to take advantage of high-field MRI, the potential impact on imaging of intra-articular elements remains unclear. The ongoing development of dedicated coils will undoubtedly help improve the performances of high-field MR imaging of the wrist.

Wrist sprains are frequently overlooked and may cause severe delayed joint dysfunction. Indirect findings on plain films are of limited sensitivity, and an early assessment of ligamentous injuries on imaging should therefore improve the diagnostic and therapeutic management of these patients. Thomas Moser et al discuss the respective roles of multidetector computed tomographic (MDCT) arthrography and MR arthrography in the assessment of wrist sprains. Jerome Renoux et al review ultrasonography of wrist ligaments, an alternative imaging modality allowing an early assessment of ligamentous injuries. Despite a few recent articles depicting the radiological anatomy of the wrist and hand, extrinsic carpal ligaments are still neglected: Mitsuhiko Nanno and Steven Viegas report a thorough study of three-dimensional MDCT imaging of carpometacarpal, intercarpal, and radiocarpal ligaments.

One topic of this issue focuses on functional imaging of the median nerve in the wrist. The prevalence of median nerve compression in the carpal tunnel is high and thus represents an obvious opportunity to evaluate new imaging techniques on peripheral nerves compressions. Several studies dealing with that topic have been recently published: Giulio Gambarota presents a fascinating work about T2 relaxometry of the median nerve at 3 and 7T and its ability to discriminate intra- and extra-axonal compartments of the nerve; Neslihan Tasdelen Kabakci et al discuss new perspectives allowed by diffusion tensor imaging and tractography of the median nerve.

I would like to thank the editors and publisher of Seminars for inviting me to serve as a guest editor. I would also like to express my great appreciation to each of the authors for their brilliant contributions to this issue, which I hope will provide readers a state-of-the art review of current concepts and future perspectives in imaging of the wrist and hand.