Orthopedic surgeons describe the glenoid fossa as the face of a clock, with the longitudinal axis defined by the supraglenoid tubercle at the 12:00 position and the inferior margin of the glenoid at the 6:00 position. Orienting the shoulder MRI exam relative to this clockface is ideal as it results in images which consistently correspond with the arthroscopists’ perspective and optimally profiles the major anatomic structures of the glenohumeral joint. In this article, Steven D. Needell, M.D. describes how to use the technique and shows its advantages in clinical cases.
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This is a 56-year-old female with a several month history of right shoulder pain. The pain started after exercise classes which involve lifting weights. The patient had no reported history of trauma.
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This 20-year-old man presented with increasing pain and swelling in his left shoulder—an ongoing problem for the prior three months. Physical exam revealed a slightly tender, indurated mass with normal overlying skin.
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Robust fat saturation can be achieved by different approaches including the application of inversion recovery sequences or advanced fat suppression pulses such as SPAIR. However, in some cases, such as the musculoskeletal imaging of the shoulder, the combination of a T2- weighted turbo spin echo (TSE) sequence with a conventional spectral fat saturation pulse is needed. When imaging obese or very tall patients, the shoulder has to be positioned off-center in many MR exams and therefore several factors will affect image quality with spectral fat saturation. This article provides tips on patient positioning and sequence set-up that will help you to achieve high quality spectral fat saturation.
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To diagnose peripheral neurologic deficits, imaging of the vertebral disks alone may not be sufficient. Depending on the clinical symptoms, the nerve roots themselves need to be evaluated in detail. In the presented case of a traumatic lesion of the brachial plexus, Markus Lentschig, MD (MR and PET/CT Center, Bremen, Germany) presents his 1.5 T imaging protocol for the evaluation of the cervical nerve roots and brachial plexus.
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