MRI of the shoulder with its excellent soft tissue discrimination, and high
spatial resolution offers the best noninvasive way to study the shoulder.
MRI images of the bone, muscles and tendons of the glenohumeral
joint can be obtained in any
oblique planes and projections.
MRI gives excellent depiction of rotator cuff tears, injuries to the biceps tendon and damage to the glenoid labrum. Shoulder
MRI is better than
ultrasound imaging at depicting structural changes such as osteophytic spurs, ligament thickening, and acromial shape that may have predisposed to tendon degeneration.
A dedicated shoulder
coil and careful patient positioning in external rotation with the shoulder as close as reasonably possible to the center of the
magnet is necessary for a good
image quality. If possible, the opposite shoulder should be lifted up, so that the patient lies on the imaged shoulder in order to rotate and fix this shoulder to reduce motion during breathing.
Axial,
coronal oblique, and
sagittal oblique proton density with
fat suppression,
T2 and
T1 provide an assessment of the rotator cuff, biceps, deltoid, acromio-clavicular
joint, the glenohumeral
joint and surrounding large structures. If a labral injury is suspected, a
Fat Sat gradient echo sequence is recommended. In some cases, a direct MR shoulder arthrogram with intra-articular injection of dilute
gadolinium or an indirect arthrogram with imaging 20 min. after intravenous injection may be helpful.
See also
Imaging of the Extremities.
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