MRI of the shoulder Coronal MRI T1 Normal Anatomy

1. MRI of the
shoulder

2. Abdulmohsin Almmdullh
Abdullah Alweleyi
Abdullah Alghafes
Abdu alaziz Almahmmod
Supervised By
Dr. Abdelmoneim. Saeed
Presented by

3. Introduction
•The shoulder is a joint that made-up of
three bones the clavicle (collarbone), the
scapula (shoulder blade), and the humerus
(upper arm bone) associated with muscles,
ligaments and tendons.
•Function: one of the most mobile joints in
the human body. The shoulder can abduct,
adduct, rotate, be raised in front of and
behind the torso and move through a full
360° in the sagittal plane.

4. shoulder bone Anatomy

5. Shoulder Anatomy muscles and
ligament

6. Axial MRI T1 Normal Anatomy

12. Coronal MRI T1 Normal Anatomy

20. Sagittal T1 MRI Normal Anatomy

26. Movement

27. Flexion: Muscles Involved:
4- Biceps (When the
forearm is flexed)
Extension: Muscles Involve:
4- Triceps (When
forearm is extended)

28. Abduction : Muscles Involve:
Adduction: Muscles Involve:

29. The most common
indications for shoulder
MRI

30. •suspected rotator cuff tear.
•Evaluation of recurrent dislocation (instability).
•Frozen shoulder syndrome.
•Osteonecrosis.
•neoplasm .
•Infection.

31. Contraindications

32. •Any electrically, magnetically or mechanically activated
implant (e.g. cardiac pacemaker, insulin pump
biostimulator, neurostimulator, cochlear implant, and
hearing aids)
•Intracranial aneurysm clips (unless made of titanium)
• Pregnancy (risk vs benefit ratio to be assessed)
•Ferromagnetic surgical clips or staples
•Metal shrapnel or bulle

33. Equipment & Patient Positioning
Equipment
• Shoulder coil or large flex coil
•Immobilization pads.
Patient Positioning
• (head first supine)
•Position the shoulder in the Shoulder coil or large flex
coil and immobilize with sand bags
•Centre the laser beam localiser over the shoulder joint
or the mid line of the coil
•Register the patient on the scanner as 'head first
supine'

34. Shoulder coil

35. Large Flex Coil

36. MRI Technique
•Supine position with the arm in slight external
rotation
•3 planes
•Axial: Above AC joint to inferior margin of
the glenohumeral joint
•Coronal oblique : Parallel to supraspinatus
tendon and scapula spine
•Sagittal oblique: Perpendicular to
supraspinatus tendon

38. Pathologies
We will talk about the pathology of shoulder,
in the following:
•Rotator cuff tear.
• Shoulder Bursitis.
•Shoulder Separation Injury.

39. Pathology
•Rotator cuff tear:
Quite simply a tear of your shoulder’s rotator cuff
tendons. A rotator cuff tear occurs in tow ways:
Trauma and Repeated micro-trauma.
The most common cause of a rotator cuff tear
is repeated micro-trauma.
Symptoms: mild or severe shoulder pain and an
inability to lift your elbow away from your body.
Treatment: Small and medium rotator cuff tears with
physiotherapy treatment, and Unfortunately, large
may require rotator cuff surgery if physiotherapy
treatment fails to assist.

40. T2T1
A T2-weighted oblique coronal from patient with
chronic shoulder pain. A rotator cuff tear is
evident along the articular side of the
supraspinatus (arrowheads), where abnormal,
though relatively low signal intensity is apparent.
A T1-weighted oblique coronal from patient with
chronic shoulder pain. A rotator cuff tear is
evident along the articular side of the
supraspinatus (arrowheads), where abnormal,
though relatively normal signal intensity is
apparent.

41. •Shoulder Bursitis:
inflammation of a structure called the ‘Subacromial
bursa’. This condition is sometimes called Shoulder
Impingement Syndrome. A common cause of
shoulder pain.
Causes: injury or trauma, Repetitive pressure on the
shoulder, Age, and Poor Posture.
Symptoms: Shoulder pain and Reduced range of
movement.
Treatment: shoulder bursitis treated by
physiotherapy and a corticosteroid injection may be
required.

42. (A) T1-weighted image with fat saturation and (B) T2-weighted
image with fat saturation depict hyperintense contrast within
the joint (yellow arrows) and fluid in the subacromial-subdeltoid
bursa (green arrows).

43. •Shoulder Separation Injury:
Is not truly an injury to the shoulder joint. The injury
actually involves the acromioclavicular joint (also called the
AC joint). The AC joint is where the collarbone (clavicle)
meets the highest point of the shoulder blade (acromion).
Cause: The most common cause is from a fall directly onto
the shoulder.
Symptoms: pain to the top of the shoulder, swelling, and
tenderness or soreness.
Treatment: - Nonsurgical treatments, such as a sling, cold
packs, and medications. - Surgery can be considered if pain
persists or the deformity is severe.

44. Coronal T2 fat sat and proton-density images reveal widening of the space
between the clavicle and acromion and complete disruption of the
acromioclavicular ligaments (red arrows). There is also superior displacement of
the clavicle with respect to the acromion, implying a disruption of the
coracoclavicular ligament as well.

45. Image quality
Introduction:
For some medical problems, a higher Tesla is
needed to produce higher-resolution
images.
Determine the coil that receive and transmit
image data back to the computer.
For some images, a stronger magnet may mean
you spend less time in the MRI to get your scan.
Some 3.0 T MRI scans can be completed in as
little as 15 minutes.

46. MRI artifacts
MRI Artifacts are numerous and give an insight
into the physics behind each sequence. Some
MRI artifacts affect the quality of the MRI exam
while others do not affect the diagnostic quality
but may be confused with pathology.

47. Almost every MRI exam includes some kind of artifacts.
Depending on their origin, one can classify them into
the following groups:
1_ Truncation artifacts: which occur
Sharp high-contrast boundaries and are
also known as the Gibbs phenomenon.
They appear as multiple, alternating
bright and dark lines – “ringing”.
They can be misinterpreted in
spinal cord or a meniscal tear in the knee.

48. 2_ Motion artifacts caused by
breathing, cardiac movement,
CSF pulsation/blood flow,
patient’s movement, which
create ghost artifacts. They can be
reduced by patient immobilization,
cardiac/respiratory gating,
saturation bands, or drugs that
slow down the intestinal peristalsis.
One can also reduce motion artifacts
by using echo-planar imaging (EPI),
a very fast MR imaging technique.

49. 3_ Aliasing artifacts occur when the anatomical
Structures located outside the field of view are mapped
at the opposite end of the image. One can eliminate them
by increasing the field of view (FOV).

50. 4_ Chemical shift artifacts appear as dark
or bright bands at the lipid-water interface
and are seen especially in case of fluid-filled
structures surrounded by fat
(e.g. eye balls in the orbits, bladder).

51. References
• http://physioworks.com.au/injuries-conditions-1/rotator-cuff-tears
• http://radsource.us/rotator-cuff-pitfalls/
• http://www.wearethecity.com/common-shoulder-pathologies/
• http://www.wearethecity.com/common-shoulder-pathologies/
• http://musculoskeletalmri.blogspot.com/2009/04/shoulder-mr-arthrography.html
• http://www.arthritis-health.com/types/bursitis/shoulder-subacromial-bursitis
• http://www.mayoclinic.org/diseases-conditions/frozen-shoulder/basics/definition/con-20022510
• http://homepage.hispeed.ch/piben/radiologie/ImageIRM.html
• http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi
=122163&ti=396541&searchkey
• http://orthoinfo.aaos.org/topic.cfm?topic=a00033
• http://www.emedicinehealth.com/shoulder_separation/page2_em.htm#what_are_shoulder_sep
aration_symptoms_and_signs
• http://musculoskeletalmri.blogspot.com/2008/05/separated-shoulder.html