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Normal Wrist MRI Report Template
Normal wrist MRI report template: carpal marrow and alignment, scapholunate and lunotriquetral ligaments, TFCC, extensor compartments and flexor tendons, median and ulnar nerves, with notes on Kienbock, ulnar variance and TFCC tear wording.
EXAMINATION: MRI [right/left] wrist without intravenous contrast. CLINICAL HISTORY: [indication, e.g. “Wrist pain”] COMPARISON: None available. TECHNIQUE: Multiplanar, multisequence MR imaging of the [right/left] wrist without intravenous contrast using a dedicated wrist coil. FINDINGS: Bones and marrow: Normal marrow signal in the distal radius, distal ulna, carpal bones and metacarpal bases. No fracture, stress reaction or marrow edema. The lunate and scaphoid show normal signal with no evidence of avascular necrosis. [Neutral] ulnar variance. Alignment: Normal carpal alignment. The scapholunate and lunotriquetral intervals are normal. No distal radioulnar joint subluxation. Articular cartilage: Preserved at the radiocarpal, midcarpal and distal radioulnar joints. Intrinsic ligaments: The scapholunate and lunotriquetral ligaments are intact. Extrinsic ligaments: The volar and dorsal radiocarpal and ulnocarpal ligaments are intact. Triangular fibrocartilage complex: Intact, with normal signal and morphology of the articular disc and its radial and ulnar attachments. The ulnar collateral ligament and the dorsal and volar radioulnar ligaments are intact. Extensor tendons: The six extensor compartments are intact without tenosynovitis. The extensor carpi ulnaris tendon is normally positioned within its groove with an intact subsheath. Flexor tendons: The flexor tendons are intact without tenosynovitis. The flexor carpi radialis and flexor carpi ulnaris tendons are intact. Carpal tunnel: The median nerve is normal in caliber and signal. No flexor retinaculum bowing or mass within the carpal tunnel. Guyon's canal: The ulnar nerve is normal. No mass. Joints: No significant radiocarpal, midcarpal or distal radioulnar joint effusion. No synovitis or erosion. Soft tissues: Unremarkable. No ganglion cyst or mass. IMPRESSION: 1. Normal MRI of the [right/left] wrist. No intrinsic ligament or TFCC tear, occult fracture or avascular necrosis.
Dictation notes
- Report the ulnar variance (neutral, positive or negative) on the coronal images — positive variance drives ulnar impaction with a central TFCC tear and lunate chondromalacia, negative variance accompanies Kienbock disease, and the finding frames the rest of the read.
- Classify a TFCC tear by Palmer type (1A central perforation, 1B ulnar peripheral, 1C distal, 1D radial attachment; class 2 degenerative) — the peripheral 1B tear is vascular and repairable, the central tear is debrided, and the letter decides the surgery.
- Scapholunate ligament tears are described by component (dorsal, membranous, volar) and by the interval width and any DISI alignment on the sagittal — a dorsal component tear with widening is the one that progresses to collapse.
- A scaphoid fracture on MRI is reported by location (waist, proximal pole, distal pole), displacement and the T1 signal of the proximal pole — low T1 signal is the osteonecrosis flag that changes the fixation plan.
- An ECU tendon that sits outside its groove on an axial image with the wrist in pronation may be a positioning artifact; subluxation is called only with subsheath disruption or a supinated-position confirmation.
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