Technical Update on Magnetic Resonance Imaging of the Shoulder

Magnetic resonance (MR) imaging with its exquisite soft tissue discrimination and multiplanar capabilities is the imaging modality of choice in the evaluation of the painful shoulder. In many cases, the study is ordered to evaluate for shoulder pain of unknown cause. Conversely, when the source of symptoms is already clear based on physical examination and plain radiography, the examination is ordered to exclude any concomitant condition that would preclude surgery, dictate an alternative surgical approach, or could be addressed at the time of surgery. MR imaging has proved to be invaluable, particularly when addressing issues regarding the rotator cuff, articular cartilage, and labroligamentous structures. Since the initial use of MR imaging, there has been continued progress with respect to the hardware and software, as well as innovations in the use of contrast agents and patient positioning. This article reviews the present state of MR imaging of the shoulder, highlighting recent advances and discussing controversies with regard to their relative strengths and weaknesses when appropriate. Specifically, we address the use of 3-T MR imaging, arthrography, unique positions adapted for evaluating different portions of the joint capsule, imaging of hardware in the postoperative patient, three-dimensional (3D) imaging techniques, and functional imaging. IS BIGGER REALLY BETTER? Imaging at 3-T