Postoperative MRI of the shoulder

Abstract

Magnetic resonance imaging (MRI) evaluation of the postoperative shoulder presents technical and diagnostic challenges related to imaging artifacts from hardware and micrometallic shavings, postsurgical scarring, and morphological alterations. Improved visualization of postoperative shoulder anatomy and pathology can be obtained with the use of metal artifact reduction techniques as well as MR arthrography. In this article we review the MR techniques that are designed to address these technical and diagnostic challenges, and we discuss the definitions and indications, normal MRI appearance, and complications of routine surgical procedures for treatment of injuries to the rotator cuff, labral ligamentous complex, and biceps tendon.

Advances in MRI around metal

“…MARS imaging can successfully be performed at the shoulder . However, since the shoulder is not located in the isocenter of the main magnetic field but peripherally with a more inhomogeneous magnetic field, severe inhomogeneity artifacts are encountered .…”

“…Within our aging society, there is an increasing prevalence of orthopedic metal implants. These include joint replacements of the hip and knee and of other joints such as the shoulder or the ankle . Other orthopedic devices of many different shapes and sizes include those for spine stabilization, arthrodesis, and fracture stabilization .…”

Imaging of the rabbit supraspinatus enthesis at 7 Tesla: a 4‐week time course after repair surgery and effect of channeling

“…5 Currently the highest clinical field strength is 3 Tesla (T), somewhat limiting the resolution and signal to noise ratio for visualization of the enthesis. 6 Higher magnetic fields and dedicated coils can generate higher spatial resolution and permit visualization of submillimeter structures such as the enthesis. Additionally, the application of biochemical sequences would allow a window into in vivo histology.…”

Clinics in diagnostic imaging (167)

“…(7) In scenarios where plain radiography, ultrasonography or CT fail to identify the underlying cause of the patient's symptoms, magnetic resonance (MR) imaging may be performed to further evaluate for potential pathology or address a specific clinical question. (23) Compared to plain radiography or CT, MR imaging is able to provide a superior assessment of the soft tissue structures surrounding the shoulder joint, which include the rotator cuff, deltoid muscle, neural structures, joint capsule and synovium. (23) Osteolysis, implant loosening and wear-induced synovitis may also now be evaluated using MR imaging due to advances in metal artefact suppression imaging techniques.…”

“…(23) Osteolysis, implant loosening and wear-induced synovitis may also now be evaluated using MR imaging due to advances in metal artefact suppression imaging techniques. (23) Notwithstanding the availability of different imaging modalities that have been shown to be useful in the evaluation of a patient with symptoms following total shoulder arthroplasty, the case we have presented illustrates how a DECT arthrogram may be used to identify glenoid component loosening, the most commonly encountered postoperative complication, particularly when preliminary plain radiographic findings are not conclusive.…”