The MRI shoulder protocol encompasses a set of different MRI sequences for the routine assessment of the shoulder joint.
Note: This article aims to frame a general concept of an MRI protocol for the assessment of the shoulder joint. Protocol specifics will vary depending on MRI scanner type, specific hardware and software, radiologist and perhaps referrer preference, patient factors e.g. implants, specific indications and time constraints
On this page:
Indications
Typical indications include shoulder pain, decreased range of motion or weakness as in:
1.5 vs 3 tesla
Musculoskeletal examinations are generally done on both 1.5 and 3 tesla. They profit from the improved spatial and contrast resolution of 3 tesla. Postoperative examinations in patients with metallic implants, however, should be done on 1.5 tesla with metal artifact reduction sequence.
Patient positioning
the patient is supine with the arm adducted in mild external rotation, for the normal examination
optional additional ABER position
Technical parameters
Coil
Multi-phased array coils are recommended.
dedicated shoulder coil
flexible coil or ring coil for ABER view
Scan geometry
in-plane spatial resolution: ≤0.4 x 0.4 mm
field of view (FOV): 120-160 mm
slice thickness: ≤3 mm
Planning
A typical MRI of the shoulder might look like as follows:
-
coronal oblique images:
angulation: parallel to the supraspinatus tendon or scapular body
volume: from subscapularis to infraspinatus muscle including the whole humeral head
slice thickness: ≤3 mm
-
sagittal oblique images:
angulation: perpendicular to the supraspinatus tendon or scapular body
volume: from lateral deltoid muscle up to the scapular body
slice thickness: ≤3 mm
-
axial images:
volume: from above the AC joint to the axilla
slice thickness: ≤3 mm
Sequences
The mainstay in musculoskeletal imaging are water-sensitive sequences, this can be achieved with conventional STIR or fat-saturated images or with intermediate-weighted images.
At least one T1-weighted sequence should be included to ease the assessment and interpretation of bone marrow and/or soft tissue lesions.
Standard sequences
Most indications for an MRI of the shoulder joint do not require any contrast media:
-
intermediate-weighted (fat-saturated)
purpose: detailed anatomy, assessment of the marrow, the rotator cuff and labrum as well as evaluation for bursitis
technique: IM fast spin echo
plane: coronal oblique, axial, sagittal oblique* (option for improved characterization of the subscapularis muscle)
-
T1-weighted
purpose: bone and/or soft-tissue characterization including the rotator cuff and capsule, assessment of muscular atrophy and fatty degeneration
technique: T1 fast spin echo
planes: coronal oblique, sagittal oblique* (option for evaluation of the rotator interval in suspected capsulitis)
-
T2-weighted
purpose: bone and/or soft-tissue characterization, Differentiating between tendinosis and tear
technique: T2 fast spin echo
plane: coronal oblique
Optional sequences
Some indications might benefit from an application of contrast media as inflammatory disease or tumors.
-
T1-weighted C+ (fat-saturated)
purpose: for inflammatory conditions like capsulitis, bursitis or in case of suspected tumor
sequence: T1 fast spin echo
plane: axial, sagittal oblique
MR arthrography
Indications for MR arthrography of the shoulder include chronic shoulder instability, multidirectional instability, microinstability or suspected labral and/or biceps pulley injury.
-
intermediate-weighted (fat-saturated)
technique: IM fast spin echo
plane: coronal oblique, ABER view
-
T1-weighted
technique: T1 fast spin echo
planes: sagittal oblique, axial
-
T1-weighted (fat-saturated)
technique: T1 fast spin echo
plane: coronal oblique, axial (option), ABER view
Practical points
in the shoulder, the protocol can and should be tailored to the specific indication or clinical question
the examination will benefit if every plane is imaged
a typical native protocol will contain 4-5 sequences
in suspected nerve compression syndromes e.g. Parsonage-Turner syndrome the coronal and axial image stacks might need an increased field of view, and the sagittal stack might need to be increased
likewise in suspected pectoralis major or latissimus dorsi injury, the field of view needs to be positioned further caudal and increased and might require a different n set of coils
Unable to process the form. Check for errors and try again.