1 / 53

MR Imaging of the Rotator Cuff

MR Imaging of the Rotator Cuff. Timothy G. Sanders, M.D. MRI Technique. -T1 and T2 FS -Oblique Coronal. -T1 and T2 FS -Oblique Sagittal. -T2 FS and GRE -Axial. Osseous Outlet and Acromion. Rotator Cuff Surrounded by a Bony Arch Mechanical Impingement leads to degeneration of the cuff

karah
Download Presentation

MR Imaging of the Rotator Cuff

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MR Imaging of the Rotator Cuff Timothy G. Sanders, M.D.

  2. MRI Technique -T1 and T2 FS -Oblique Coronal -T1 and T2 FS -Oblique Sagittal -T2 FS and GRE -Axial

  3. Osseous Outlet and Acromion • Rotator Cuff Surrounded by a Bony Arch • Mechanical Impingement leads to degeneration of the cuff • Anterior Acromion Most Important Structure Leading to Impingement

  4. Normal Osseous Outlet Clavicle Acromion Coracoid

  5. Acromial Types Type I

  6. Acromial Types Type II

  7. Acromial Types Type III

  8. Acromial Types Type IV

  9. Acromial Down Sloping Anterior Down Sloping Evaluated on Sagittal Images Axis of Acromion Normal Axis of Acromion Anterior Down Sloping

  10. Acromial Down Sloping Lateral Down Sloping Evaluated on Coronal Images Axis of Acromion Normal Axis of Acromion Lateral Down Sloping

  11. Acromial Spur -Spur -Contains Marrow Signal -Deltoid Tendon (Mimics Spur) -Black (No Marrow Signal)

  12. Os Acromiale

  13. Os Acromiale Ossification Center Usually Closes by 22-25 y.o. Normal Appearing Anterior Acromion on Axial Image

  14. Os Acromiale (Axial Images) -Can be unstable resulting in impingement of Rotator Cuff during contraction of the deltoid

  15. Os Acromiale (Sagittal Images) Normal AC Joint “Double” AC Joint Sign

  16. Os Acromiale AC Joint Os Acromiale “Double” AC Joint

  17. Acromion • Type (I, II, III) • Anterior/ Lateral Down Sloping • Inferior Spur • Os Acromiale

  18. Coracoacromial Ligament -Thick Ligament can Impinge on Anterior Rotator Cuff -Normal Ligament <3 mm

  19. Acromioclavicular Joint -Does it cause mass effect on rotator cuff? -AC degenerative change, capsular hypertrophy -Cuff less rigidly confined

  20. AC Joint Sprain/Separation Grade I -Capsular edema, effusion -No elevation Grade II -Capsular edema, effusion -Elevation distal clavicle

  21. Osteolysis of Distal Clavicle Post-traumatic osteolysis -Complication of trauma (occurs within 2 months of injury, self limiting) -Repetitive stress (wt. lifters) -X-ray: loss of normal cortical line- distal clavicle

  22. Coracoid Impingement -Narrowed C-H Distance can Impinge on Subscapularis -Normal Coracohumeral Distance is 11 mm

  23. Osseous Outlet and Acromion • Acromion • Type, Down Sloping, Spur, Os Acromiale • AC Joint • Deg. Change, Hypertrophy (mass effect?) • Coracoacromial Ligament (thickened?) • Coracohumeral Impingement (subscap?)

  24. Rotator Cuff (Sagittal) Supraspinatus; Infraspinatus; Teres Minor; Subscapularis

  25. Rotator Cuff (Coronal) -Primary Plane for Evaluating the Supraspinatus Tendon -Musculotendinous Junction at 12:00 Position

  26. Rotator Cuff (Axial Plane) -Supraspinatus Tendon

  27. Rotator Cuff (Axial Plane) -Primary Plane for Evaluating Subscapularis -Infraspinatus Located Posteriorly

  28. Rotator Cuff (Coronal) -Subscapularis - Located Anteriorly - Multi-slip tendon - Infraspinatus - Located Posteriorly - Slopes upward

  29. Rotator Cuff Pathology • Tendonopathy • Tear • Partial Thickness, Full Thickness, Complete • Musculotendinous Retraction • Fatty Atrophy • HADD/ Calcific Tendonitis

  30. Tendonopathy -Increased T1-signal; thickened/ attritional changes (thinned) -Intermediate T2-signal (No Fluid Signal)

  31. Partial Thickness Tear (Articular) -T2: Fluid Signal extending into black tendon -Partial Thickness Undersurface Tear

  32. Partial Thickness Tear (Bursal) -Fluid Signal Extending into the Bursal Surface of the Supraspinatus Tendon

  33. Partial Thickness Tear (Interstitial) -Fluid Signal within the Substance of the Tendon -Does Not Involve the Articular or Bursal Surface

  34. Intramuscular Cyst Rotator Cuff -High Association with 1. P.T. Undersurface Tear 2. Small F.T. Tear 3. DDX: Paralabral Cyst

  35. Intramuscular Cyst Rotator Cuff -Intramuscular Cyst Supraspinatus -Small Undersurface P.T. Tear

  36. Delamination (retraction of deep fibers)

  37. Full Thickness Tear -Fluid extends through the entire thickness of the tendon (superior to inferior) -Mild retraction of musculotendinous junction

  38. Massive Tear Musculotendinous retraction -Measure in centimeters; can affect prognosis

  39. Fatty Atrophy -Mild, Moderate, Severe -Streaks of high signal on T1 -Loss of muscle bulk (Sagittal)

  40. Calcific Tendonitis -HADD: Dark Globular Area on all Pulse Sequences -Blooming Artifact on Gradient Echo Images

  41. Subscapularis -Subscapularis: Attaches to lesser tuberosity -Extra-articular Biceps: Best Seen on Axial Image -In Bicipital Groove; Transverse Ligament

  42. Avulsion of Subscapularis -Subscapularis Muscle can Avulse off of Lesser Tuberosity -Associated with Dislocation of the Biceps Tendon -Seen best in Axial Plane

  43. CH Ligament Biceps Tendon (Anatomy) LHBT LHBT • Coracohumeral ligament primary stabilizer of LHBT

  44. Biceps Tendonitis/ Tear -Thick Tendon; Increased Signal -Intra-articular -Extra-articular

  45. Biceps Tendon (Anatomy) • Subscapularis/ transverse humeral ligament • Secondary stabilizer

  46. Biceps Subluxation: Pattern I • CHL: intact • 2. Subscapularis tendon: complete tear • - No Dislocation of LHBT

  47. Pattern II: Intra-articular • CHL: torn • Subscapularis tendon: complete tear • - Intra-articular dislocation of LHBT

More Related