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presentation detailing approach to MRI shoulder mainly basics including anatomy.

Published in: Healthcare
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  1. 1. MRI OF SHOULDER JOINT Dr Krishna Kiran MD.DNB.FRCR Radiologist Calicut This presentation is intended for medical and allied professionals.
  2. 2. What is T1,T2.. And many other fancy names used in MRI..?? T2 T1 FAT SUPPRESSED STIR/PDFS Common sequences in MRI shoulder
  3. 3. How do you do shoulder MRI.. Shoulder MRI is done in a plane parallel to supraspinatus. Generally sequences obtained are Coronal plane T1, T2, Fatsuppressed (STIR or PDFS) Axial - T1, fatsuppressed Sagittal - T2 and fat suppressed.
  4. 4. Key section in shoulder coronal image in the middle third
  5. 5. Anterior coronal section
  6. 6. Posterior coronal section shoulder
  7. 7. Sagittal section
  8. 8. Axial anatomy
  9. 9. After review of anatomy , Let us proceed to our case.
  11. 11. Full thickness tear supraspinatus tendon except fibers in anterior third
  12. 12.  Complete tears of supraspinatus tendon are accompanied by muscle atrophy and fatty infiltration.  These are important negative prognostic factors for tendon repair and shoulder arthroplasty.  Muscle thickness using Fat occupancy ratio and fatty infiltration of muscle can be assessed on MRI.
  13. 13. Fat occupancy ratio
  14. 14. Reduced fat occupancy Normal fat occupancy
  15. 15. Fatty infiltration supraspinatus Normal supraspinatus
  16. 16. Case 2  ? Rotator cuff tear
  17. 17. Avulsion Fracture greater tuberosity of humerus
  18. 18. Case 3  ?RCT
  19. 19. Rimrent or PASTA tear
  20. 20. Rimrent or PASTA tear  A partial tear that extends to articular surface does not extent to bursal surface.
  21. 21. Case 4  Recurrent Dislocation shoulder
  22. 22. Anterior middle posterior Coronal sections
  23. 23. Posterior sections of shoulder
  24. 24. Hill Sach Lesion
  25. 25. Anterior labral tear Normal anterior labrum for comparison
  26. 26. Labral clock Clockwise approach to labrum is the easiest way to diagnose labral tears and differentiate them from normal variants.
  27. 27. ABER view Abduction external rotation view of shoulder is utilized to detect subtle soft tissue pathology of anteroinferior labrum and rotator cuff.
  28. 28. Types of anteroinferior labral tears. Bankart lesion Perthe lesion ALPSA lesion
  29. 29. Case 5  Shoulder pain and limitation of movement.
  30. 30. Anterior middle posterior
  31. 31. Anterior capsule thickening indicative of adhesive capsulitis. Normal for comparison
  32. 32. Case 6 Shoulder pain on overhead hand movement
  33. 33. Anterior middle posterior
  34. 34. Anterior middle posterior
  35. 35. Supraspinatus tendonitis / tendinopathy MRI shows tendon enlargement and mild intratendinous hyperintense signal.
  36. 36. Case 7  Suspected scapula fracture
  37. 37. 3D CT is done to assess scapula and adjacent injuries.
  38. 38. Case 8  An athlete complains of pain on throwing and overhead movement of arm.
  39. 39. MR Arthrogram
  40. 40. Hyperintense signal within labrum extending posteriorly. Indicative of SLAP lesion. (Superior Labral anteroposterior tear)
  41. 41. Labrum shows several anatomical variations. Conventional MRI is not accurate in diagnosing labral tears (40-70% sensitivity and specificity) MR Arthrography is more accurate (90-95% sensitivity and specificity)
  42. 42. History of Trauma CASE 1O
  43. 43. AP shoulder
  44. 44. Y view or scapula lateral
  45. 45. Internally rotated humerus giving light bulb appearance. Y view showing Posterior dislocation posterior dislocation.
  46. 46. Other views of shoulder Outlet or Neer`s view
  47. 47. Other views Axillary view
  48. 48. What about ultrasound..? Useful tool in •Rotator cuff tendinopathy or tear. •Calcific tendonitis. •Subacromial bursal effusion. Limitations •Many parts of joint can not be assessed. •Operator dependent
  49. 49. What is magic angle phenomenon..? Some sequences reveal mild bright signal / hyperintensity within substance of supraspinatus. If seen without tendon enlargement is indicative of artifact called magic angle phenomenon. Is said to be due to orientation of collagen fibers. Coronal STIR Coronal T2
  50. 50. What is difference between low strength and 1.5T magnet..? 0.2T 1.5 T
  51. 51. How accurate are shoulder MRI reports..?  15-20% of asymptomatic adults on shoulder MRI revealed rotator cuff tears.  A shoulder surgeon with correlation between arthroscopy and MRI may be able to correlate image findings better.  In doubtful cases it is better to mutually discuss and proceed. Sher et al JBJS 1995
  52. 52. What are types of acromion..? Type 2 and 3 are associated with shoulder impingement
  53. 53. QUIZ  Shoulder , arm pain after suddenly lifting heavy weight
  54. 54. SLAP tear extending to biceps anchor
  55. 55. Take home points..  Shoulder is a complex joint , imaging also tends to be complex and prone for errors.  When in doubt discuss and proceed.  Signal within tendon may not be significant , remember magic angle ..!!