Faculty Bibliography

OBJECTIVE:This study was performed to determine whether a modified version of the classic STIR sequence provides similar information about the integrity of the rotator cuff tendon as the commonly used fat-suppressed T2-weighted fast spin-echo sequence. SUBJECTS AND METHODS/METHODS:Sixty-one consecutive MRI examinations of the shoulder in 57 patients were performed using a coronal oblique T1-weighted spin-echo sequence, a modified version of the STIR sequence, and a fat-suppressed T2-weighted fast spin-echo sequence. Three reviewers independently assessed the rotator cuff tendon using the coronal oblique modified inversion recovery sequence and T1-weighted spin-echo sequence. After a minimum of 4 weeks, reviewers assessed the rotator cuff tendon using the fat-suppressed T2-weighted fast spin-echo sequence and T1-weighted spin-echo sequence. The kappa statistic was used to measure the degree of concordance between interpretations when each sequence was used independently. The conditional probability that a full- and a partial-thickness tear would be diagnosed on both sequences was calculated. Image quality was assessed in a side-by-side comparison. RESULTS:The overall weighted kappa score was 0.82, which indicates excellent concordance between the two sequences. If a full-thickness tear of the rotator cuff tendon was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was a 94.1% probability that the same conclusion would be reached using the modified inversion recovery sequence. If a partial-thickness tear was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was an 80.3% probability that the same conclusion would be reached with the modified inversion recovery sequence. Fat suppression in the modified inversion recovery sequence was superior to that in the T2-weighted fast spin-echo sequence in 26-39% of the examinations. CONCLUSION/CONCLUSIONS:The modified inversion recovery sequence and fat-suppressed T2-weighted fast spin-echo sequence provide similar information about the integrity of the rotator cuff tendon.

Part I of this comprehensive review on magnetic resonance imaging of the elbow discusses normal elbow anatomy and the technical factors involved in obtaining high-quality magnetic resonance images of the elbow. Part I also discusses the role of magnetic resonance imaging in evaluating patients with osseous abnormalities of the elbow. With proper patient positioning and imaging technique, magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the osseous structures of the elbow. Magnetic resonance imaging can detect early osteochondritis dissecans of the capitellum and can be used to evaluate the size, location, stability, and viability of the osteochondritis dissecans fragment. Magnetic resonance imaging can detect early stress injury to the proximal ulna in athletes. Magnetic resonance imaging can detect radiographically occult fractures of the elbow in both children and adults. Magnetic resonance imaging is also useful in children to further evaluate elbow fractures which are detected on plain-film radiographs.