MR Arthrography of the Elbow and Wrist

This article describes the present status and future directions of magnetic resonance arthrography (MRA) of the elbow and the wrist. The indications are evolving and not yet clearly defined. MRA of the elbow is useful for evaluation of collateral ligaments, the articular surfaces, and suspected loose bodies. MRA of the wrist currently is typically reserved for difficult cases. A description and a comparison of direct and indirect MRA techniques is provided. Direct MRA produces reliable joint enhancement with capsular distension. Indirect MRA does not require a radiologist experienced with arthrography but if it is improperly performed, results in suboptimal delineation of intra-articular structures. A review of pertinent normal anatomy and common variants is included as well as a discussion of pathology that is suitably demonstrated by MRA technique. Typical examples of normal variants, abnormalities, and pitfalls are illustrated to reduce interpretive error for radiologists using MRA of the elbow and the wrist.