Background <p>Wrist ganglion cysts (GCs) are frequently identified on magnetic resonance imaging (MRI); however, the relationship between cyst localization, cyst size, and associated MRI-detected pathologies remains unclear. This study aimed to evaluate whether the anatomical localization of wrist GCs is associated with cyst size and the presence of accompanying pathologies.</p> Methods <p>This retrospective cross-sectional study included adult patients who underwent wrist MRI between 2023 and 2024 and were diagnosed with a GC. Cyst localization was classified as dorsal or volar. Cyst size was assessed by calculating cyst volume (mm³) based on the maximum diameters measured in three orthogonal planes on MRI. Accompanying pathologies, including distal radioulnar joint (DRUJ) injury, triangular fibrocartilage complex (TFCC) injury, bone cysts, tenosynovitis, and bone marrow edema, were recorded as binary variables. Cyst size was compared between dorsal and volar localizations using the Mann–Whitney <i>U</i> test. Associations between localization and accompanying pathologies were evaluated using Chi-square test. A multivariable logistic regression analysis was performed to evaluate the association between cyst localization and TFCC injury after adjustment for age and sex. Effect sizes were reported with corresponding 95% confidence intervals, including odds ratios and Cliff’s delta where appropriate.</p> Results <p>A total of 226 wrist GCs were analyzed, including 155 (68.6%) female and 71 (31.4%) male patients. Of these, 138 (61.1%) were located dorsally and 88 (38.9%) in the volar wrist. The median cyst volume did not differ significantly between dorsal and volar locations (<i>p</i> = 0.163), with a negligible effect size (Cliff’s <i>δ</i> = 0.10). Volar GCs were observed in older patients and significantly associated with accompanying pathologies (<i>p</i> = 0.007), although the effect size remained small (Cliff's <i>δ</i> = 0.17). Among individual pathologies, the association between volar localization and TFCC injury did not retain significance after correction for multiple comparisons (<i>p</i> = 0.067). In multivariable logistic regression adjusted for age and sex, volar localization remained independently associated with TFCC injury (OR 2.12, 95% CI 1.02–4.43, <i>p</i> = 0.045).</p> Conclusion <p>Wrist GC localization was not significantly associated with cyst size. Although volar GCs showed a higher frequency of accompanying pathologies—particularly TFCC injury—this finding should be interpreted as an observed trend rather than a definitive association.</p>