title: High resolution 3.0 Tesla MR imaging findings in patients with bilateral Madelung's deformity.
abstract: OBJECTIVE
  Madelung deformity (MD) is a rare, normally painful abnormality of the wrist and forearm which characteristically begins in adolescence. Usually the deformity appears between the age of 8 and 14 years, often progressing from initially mild functional pain to fatigue and loss of strength and finally, reduced mobility. We present the MR-findings in three patients with bilateral MD, using a high-resolution imaging protocol adapted for 3.0 Tesla (3.0 T) examinations.
  
  
  METHODS
  Wrist images of three patients were acquired at a 3.0 T Scanner (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands), using a dedicated phased array coil. The imaging protocol consisted of coronal T1-weighted Turbo-spin-echo (T1w-TSE) and coronal and sagittal T2-weighted TSE sequences (T2w-TSE).
  
  
  RESULTS
  MR-images of these three girls demonstrated severe volar bayonet configuration of the forearms with a dorsal prominence of the ulnar head, also a curved distal radial articular surface with increased ulnar angulation, due to a deceleration of growth in the ulnar portion of the distal epiphysis. The proximal carpal row showed pyramidal configuration. Also visible was a prominent short radiolunate ligament, the so called Vickers ligament, which originates from the ulnar border of the radius, inserts into the volar pole of the lunate and likely contributes to carpal pyramidalization. Furthermore, the images demonstrated an anomalous hypertrophied and elongated volar radiotriquetral ligament which, to our knowledge, has been described elsewhere only in another case.
  
  
  CONCLUSIONS
  High resolution imaging at 3.0 T permitted a detailed analysis of the complex pathomorphology in patients with MD. Investing the better signal-to-noise ratio at higher field strengths into spatial resolution an excellent image quality could be obtained, depicting the Vickers ligament and the anomalous volar radiotriquetral ligament in this rare disease.
authors.affiliation: Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, Münster, Germany. cstehling@uni-muenster.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Stehling
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nassenstein
authors.forename: Rainald
authors.initials: R
authors.lastname: Bachmann
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Volker
authors.initials: V
authors.lastname: Vieth
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D011859:Radiography; D011884:Radius / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014457:Ulna / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014955:Wrist Joint / Q000002:abnormalities* / Q000000981:diagnostic imaging; D055815:Young Adult