MR Arthrography of Shoulder

Christine B. Chung1, Leopoldo M. Gigena1, Donald Resnick1

1 Veterans Affairs, San Diego Healthcare System, University of California San Diego, La Jolla, California
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A22.2
DOI:  10.1002/0471142719.mia2202s03
Online Posting Date:  February, 2002
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Abstract

The glenohumeral joint boasts the greatest range of motion of any peripheral joint in the body, but not without cost; it is also the most frequently dislocated joint in the body. Stability of this articulation is limited for two major reasons. The articulating surface of the glenoid is significantly smaller than that of the humeral head, and the joint capsule is redundant and provides little support. This unit presents a basic MR arthrography protocol for evaluation of glenohumeral joint instability.

     
 
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Table of Contents

  • Basic Protocol 1: Role of Evaluation in Shoulder Instability
  • Commentary
  • Literature Cited
  • Figures
  • Tables
     
 
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Materials

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Figures

  •   FigureFigure a2.20.1 The arm is extended at the patient's side and in neutral position, with the thumb pointed towards the ceiling. The coil is placed over the glenohumeral joint.
  •   FigureFigure a2.20.2 SPGR coronal localizer. The grid lines are set from above the acromioclavicular joint and extend to a point below the inferior aspect of the glenohumeral joint.
  •   FigureFigure a2.20.3 The grid lines are placed perpendicular to the spine of the scapula to perform the sagittal oblique images.
  •   FigureFigure a2.20.4 The grid lines are placed parallel to the spine of the scapula to perform the coronal oblique images.
  •   FigureFigure a2.20.5 The grid lines are located parallel to the supraspinatus tendon to perform the coronal oblique images.
  •   FigureFigure a2.20.6 ABER position with coil placement. See the abducted arm and the coil behind the axilla.
  •   FigureFigure a2.20.7 Localizer images parallel to the long axis of the humerus.
  •   FigureFigure a2.20.8 Example of the transverse oblique in the ABER position. This picture also shows a Perthes lesion (designation for an avulsion of the anteroinferior portion of the glenoid labrum without displacement and with stripping of the periosteal membrane).

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Literature Cited

Literature Cited
   Chandnani, V.P., Yeager, T.D., DeBernardino, T., Christensen, K., Gagliardi, J.A., Heitz, D.R., and Hansen, M.F. 1993. Glenoid labral tears: Prospective evaluation with MRI imaging. MR arthrography, and CT arthrography. Am. J. Roentgenol. 161:1229‐1235.
   Chung, C.B., Dwek, J.D., Cho, G.J., Lektrakul, N., Trudell, D., and Resnick, D., Rotator cuff interval: Evaluation with MR imaging and MR Arthrography of the shoulder in 32 cadavers. J. comput. Assisted Tomogr. In press.
   Flannigan, B., Kursunoglu‐Brahme, S., Snyder, S., Karzel, R., Del Pizzo, W., and Resnick, D. 1990. MR arthrography of the shoulder: Comparison with conventional MR imaging. Am. J. Roentgenol. 155:829‐832.
   Gusmer, P.B., Potter, H.G., Schatz, J.A., Wickiewicz, T.L., Altchek, D.W., O'Brien, S.J., and Warren, R.F. 1996. Labral injuries: Accuracy of detection with unenhanced MR imaging of the shoulder. Radiology 200:519‐524.
   Hajek, P.C., Sartoris, D.J., Gylys‐Morin, V., Haghighi, P., Engel, A., Kramer, F., Neumann, C.H., and Resnick, D. 1990. The effect of intra‐articular gadolinium‐DTPA on synovial membrane and cartilage. Investig. Radiol. 25:179‐183.
   Hajek, P.C., Sartoris, D.J., Neumann, C.H., and Resnick, D. 1987. Potential contrast agents for MR arthrography: In vitro evaluation and practical observations. Am. J. Roentgenol. 149:97‐104.
   Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐Raven, Philadelphia.
   Tirman, P.F., Bost, F.W., Steinbach, L.S., Mall, J.C., Peterfy, C.G., Sampson, T.G., Sheehan, W.E., Forbes, J.R., and Genant, H.K. 1994. MR arthrographic depiction of tears of the rotator cuff: Benefit of abduction and external rotation of the arm. Radiology 192:851‐856.
   Vahlensieck, M., Peterfy, C.G., Wischer, T., Sommer, T., Lang, P., and Schlippert, U., Genant, H.K., and Schild, H.H. 1996. Indirect MR arthrography: Optimization and clinical applications. Radiology 200:249‐254.
   Zanetti, M. and Hodler, J. 1997. Contrast media in MR arthrography of theglenohumeral joint: Intra‐articular gadopentetate vs saline: Preliminary results. Eur. Radiol. 7:498‐502.
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