Shoulder MRI

Indications : Evaluation of impingement syndrome and instability .(clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed) Evaluation of frozen shoulder syndrome .(soft tissue capsular lesion accompanied by painful and restricted active and passive motion at the glenohumeral joint) Tears in shoulder capsule . Tendonitis.

Shoulder MRI
Equipment : Shoulder coil . circular surface coil

Pt position : Supine , head first ,arm by sides the shoulder placed within coil over humeral head ,the horizontal line pass through joint .

Shoulder MRI
Rotor cuff muscles : Supraspinatous Infraspinatous Subscapularis Teres minor

Shoulder MRI
Protocol : Localizer Axial T2 or PD fat sat Paracoronal T2 fat sat Paracoronal T1 Parasagittal T2

Shoulder MRI
Axial : Plot on coronal localizer 3 mm thickness 20% gap PD parameters TR :3000 TE : 35

Shoulder MRI

Paracoronal : Parallel to supraspinatus muscle on axial slice . 3 mm thickness 20% gap

Shoulder MRI

Parasagittal Parallel to glenoid cavity. 3 mm thickness 20% gap

Shoulder MRI

Axial PD Fat suppression

paraCoronal PD

Knee MRI
Indications : Assesmnet of internal derangment of the joint . Evaluation of chondromalcia patella and patella tracking . Diagnosis of bone tumors Other knee disorder .

Knee MRI
Advantages : Fast ,non invasive ,informative ,high accuracy ,low claustrophobic , majority of knee content is soft tissue and water .

Knee MRI
Equipment : Knee coil . Position : Supine , feet first , External rotation 15 Centre of the coil.

Knee MRI
Main anatomy : femur and tibia Collateral ligament ( medial and lateral ) Cruciate ligament (ant. And post. ) *** responsible for knee stability Medial and lateral meniscus ( ant. And post. Horn ) *** Prevent fraction of bones

Knee MRI
Protocol : Localizer : plan sagittal and coronal on axial localizer (off centre position) Coronal fat sat coronal PD Sagittal fat sat Sagittal PD Axial T2 ( optional )

Knee MRI

Coronal sequence : Plot on sagittal and axial parallel to condyles. 3 mm thickness No sat slab

Knee MRI

Sagittal sequence : Plot on axial and coronal parallel to condyles .

External rotation For Ant. Cruciate ligamnet

Knee MRI
Sagittal sequence : Plot on axial and coronal without angulations to show the posterior cruciate ligament .

Knee MRI
Axial sequence : Plot on sagittal Same parameters Axial doesnt provide good information for the ligaments and meniscus , better in case of neoplasm ,cyst and other pathology not related to ligaments

Knee MRI
The anterior cruciate ligament is delineated best at 15-20 of external rotation . The posterior cruciate ligament at 0-5 of internal rotation . PD TR :3000 TE: 20-45

Knee MRI

Knee MRI

Ankle MRI
Indications : Assessment of tendonitis Achilles tendon rupture or tear Avascular necrosis Visualization of soft tissue abnormalities. Equipment : Exremity coil .

Ankle MRI
Pt position : Supine , feet first Foot is dorsiflexed The horizontal line at level of malleoli .

Ankle MRI
Protocol : Localizer Sagittal T1 Sagittal fat sat Axial PD Axial Fat sat Coronal T2

Ankle MRI

Sagittal : Plot on axial localizer 3 mm thickness 20% gap FOV : large enough to include toes Sat slab superior to slices

Ankle MRI

Coronal : Plot on sagittal localizer

Ankle MRI

Axial : Plot on sagittal localizer 4 mm thickness 20% gap Superior sat slab

Ankle MRI (additional )

Optimized imaging of the : 1- calcaneonavicular and deltoid ligaments: coronal slice in maximum dorsiflexion ( 10-20 ) 2- anterior and posterior talofibular ligaments : axial slice in maximum dorsiflexion ( 10-20 ) Calcaneofibular ligament : axial slice in maximum plantar flexion (40-50) Deltoid ligament : coronal slice in maximum plantar flexion (40-50)

MRCP

MR Cholangiopancreatography Pt . Position : Supine, feet first, arms crossed on chest with hands on shoulders in order to prevent arm wrap-around artifact. Equipment : Phased array body coil

MRCP
Protocol : Locator coronal Axial T2 HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) sequence Thick slab Thin slab

Locator

Thick slab

Radical with all direction Pt should suspend respiration

Thin slab paracoronal

The best thick slab taken as thin slab Use of respiratory triggers