Shoulder MRI Arthrography, an educational review of technique and common pathological findings

Congress:

ECR 2020

Poster Number:

C-10109

Type:

Educational Exhibit

Keywords:

Not applicable, Education and training, Arthrography, MR, Fluoroscopy, Musculoskeletal joint, Anatomy, Musculoskeletal

Authors:

P. kelly, C. ODonnell, G. Rahmani, S. Davey; galway/IE

DOI:

10.26044/ecr2020/C-10109

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10109

Fig. 2: Anterior labrum is deficient from 1 o'clock to 3 o'clock. Associated thickening...

Fig. 3: Low signal filling defect anterosuperior to the lesser tuberosity and biceps...

Fig. 4: Anterior and posterior labral tears with good distension of the glenohumeral...

Fig. 5: Extensive labral tear involving the anterior and anteroinferior labrum from the...

Learning objectives

MRI Arthography of the shoulder joint, an educational review of technique and common pathological findings.

Background

MRI Arthography is primarily performed in the assessment of shoulder instability. This mainly involves evaluation of the glenoid labrum, glenohumeral ligaments and the surrounding rotator cuff. MRI Arthography is superior to conventional MR imaging in the assessment of shoulder instability. Joint distension with contrast allows for accurate depiction of the labrum from the overlying capsule and the presence of contrast within the labral substance allows for detection of tears and labral detachment. We describe our experience of MR shoulder arthrography including technique and common pathological...

Findings and procedure details

Direct MR Arthrography of the shoulder is performed under aseptic conditions in the fluoroscopy suite at our institution. The procedure is explained to the patient and written consent is obtained. The procedure is considered extremely safe however consent in obtained for potential complications including pain, infection, bleeding, chemical synovitis and contrast reactions. The MRI checklist is then completed. The approach under fluoroscopic guidance is either anterior or posterior. The rotator interval approach yields less artefacts. We use a 21G spinal needle with the shoulder held...

Conclusion

MR shoulder arthrography is primarily used in the assessment of shoulder instability. A knowledge of the procedure is essential to avoid complications and maximise diagnostic yield. A knowlege of shoulder joint anatomy and common pathological conditions is essential in MR arthrography interpretation. Labral tears, ligamentous injury, Hill Sachs lesions and loose bodies constitute the main pathological findings in our institution.

Personal information and conflict of interest

P. Kelly; Galway/IE - nothing to disclose C. Odonnell; Galway/IE - nothing to disclose G. Rahmani; Galway/IE - nothing to disclose S. Davey; Galway/IE - nothing to disclose

References

1. Huang T, Liu J, Ma Y, Zhou D, Chen L, Liu F. Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis. Journal of Orthopaedic Surgery and Research. Dec 12,14 (1):436. 2. Expert Panel on Musculoskeletal Imaging:, Amini B, Beckmann NM, Beaman FD, Wessell DE, Bernard SA, Cassidy RC, Czuczman GJ, Demertzis JL, Greenspan BS, Khurana B, Lee KS, Lenchik L, Motamedi K, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria Shoulder Pain-Traumatic. Journal of the American College...