Timing Parameters	Series 2	Series 3		A routine protocol consists of T1-weighted or PD-weighted, high resolution FSE sequences in the coronal plane, as well as a fat-suppressed T2-wtd FSE sequence, typically with TE between 40-50ms. Because the Improved Fat Sat results in decreased image SNR relative to the conventional Fat SAT, a TE between 30-40ms is used for the fat-suppressed T2-weighted sequence on our LX scanner. The FOV is 6 to 8cm using a matrix size of 512 x 384. Subchondral sclerosis, or internal degeneration within the TFCC can be assessed on T1-weighted or PD-weighted coronal images. To assess the articular cartilage of the carpus in the coronal plane, and to adequately assess the intrinsic ligaments (most importantly the scapholunate and lunotriquetral ligament complexes) fat-suppressed FSE is the best pulse sequence to show high contrast between fluid signal intensity and intermediate signal intensity articular cartilage. A gradient echo sequence may be used in the coronal plane but is less adequate for showing contrast between intrinsic ligaments and adjacent fluid. However, this sequence does show internal degeneration within the TFCC articular disc to a greater extent than the fat-suppressed FSE sequence. (Fig. 6.1) Coronal images must cover through the flexor tendons (volar) to the extensor tendons dorsally. If the TFC, scapholunate and lunotriquetral ligaments are not in the same plane, the wrist is improperly rotated.
	Coronal T1 FSE-XL	Coronal FSE-XL FS
TR/TE	800/min full	3000/36*
ETL	2	8
Flip Angle	—	—
RBW	12.5kHz	12.5kHz
FOV	8cm	8cm
Matrix	320 x 256	256 x 224
ZIP512	yes	yes
Slice Thickness	2mm	2mm
Interslice Gap	0.5mm	0.5mm
NEX	2	3
Acquisition Time	3:30	4:20
Fat Sat	no	yes
Tailored RF	yes	yes
No Phase Wrap	yes	yes
Flow Compensation	no	no
Freq	S/I	S/I

Figure 6.1 (click on images for enlarged view) Comparison of (A) T1-weighted and (B) fat-suppressed T2-weighted FSE coronal images of the wrist. The improved ligament/fluid contrast on the fat-suppressed T2-weighted image allows for the identification of fluid across the volar scapholunate ligament. (C)The fat-suppressed T2-weighted FSE axial image can be used to confirm volar scapholunate ligament disruption.

Figure 6.1(D) T1-Weighted Coronal Wrist Image (click on image for enlarged view)