The purpose of this study was to implement a 5-minute shoulder MRI protocol consisting of accelerated 2D turbo spin echo (TSE) sequences with a deep learning (DL) reconstruction at 1.5 and 3 T and to compare the image quality and diagnostic performance to that of a standard 2D TSE protocol.

Thirty patients who underwent shoulder MRI at 1.5 and 3 T were prospectively enrolled in this institutional review board-approved study after obtaining written informed consent between October 2020 and June 2021. Each patient underwent two MRI examinations: standard TSE (TSES) protocol and fast, prospectively undersampled TSE with DL reconstruction (TSEDL). Two musculoskeletal radiologists independently assessed image quality and visualization of anatomical structures using a Likert scale ranging from 1-5 (5 best) as well as the diagnostic performance concerning pathologic shoulder lesions. Wilcoxon signed-rank test and kappa statistics were performed to compare the two protocols.

Overall image quality was evaluated to be superior in TSEDL versus TSES (p<0.001). Noise and edge sharpness were evaluated to be significantly superior in TSEDL versus TSES (noise: p<0.001, edge sharpness: p<0.05). No difference was found concerning qualitative diagnostic confidence and clarity of anatomical structures (p>0.05) and quantitative diagnostic performance for pathologic shoulder lesions when comparing the two sequences.

Fast 5-minute TSEDL MRI protocol of the shoulder ifeasible in clinical routine at 1.5 and 3 T, without limitationconcerning the diagnostic performance and allowa reduction of scan time of more than 50 % compared to standard TSEprotocol.

MRI of the shoulder has become the most widely used imaging modality in patients with shoulder pain due to the comprehensive noninvasive diagnostic of the pathologies such as rotator cuff or biceps tendon tears, and glenoid labral abnormalities. As the novel 5-minute TSEDL protocol of the shoulder is feasible in daily clinical routine at 1.5 and 3 T, enabling a reduction of acquisition time above 50% combined with improvement of image quality and equivalent diagnostic performance of shoulder abnormalities compared to standard TSE imaging, it could set the stage for the introduction of ultra-fast protocols in shoulder MRI in clinical routine and would allow more patients to receive a shoulder MRI in a timely manner.

3D isotropic MR imaging use is increasing in Orthopedics, but shoulder evaluation is routinely limited to 2D imaging. The aim was to obtain correlations of multiplanar 2D MRI versus 3D volume MRI isotropic reconstructions for rotator cuff and labral tears with reference standard of surgical findings.

An IRB-approved retrospective study of shoulder MRIs over 2 years. 87 patients with 3D MRI and shoulder arthroscopy by a single surgeon were included. Patients underwent 3-Tesla imaging, with conventional three-plane high-resolution 3.0 mm 2D imaging (scan-time = 15 minutes) and sagittal 3D TSE imaging sequence with 0.7mm isotropic voxels (scan-time= 6-7 minutes). Scapular plane-oriented contiguous 0.7mm MPRs of the 3D images were created by a research student and sent to PACS. MSK fellowship trained radiologists evaluated all cases. Variables included labral tear presence, location, length, Ellman grading of tear, thickness, and width. Correlation analysis was performed.

87 pre-operative cases with a mean BMI of 24.87 (SD=4.32) were evaluated, blinded to 2D vs. 3D MR and surgical findings. Comparison of 2D vs. 3D MRI showed poor agreements for labral and rotator cuff tears (Cohen’s Kappa= 0.21, 0.29) while RCT grade, thickness, and labral tear length yielded fair agreements (ICC= 0.43, 0.53, 0.52, respectively). Mean labral tear length on 2D MRI was 8.9mm (range 4mm-32mm) while 3D MRI was 10.20mm (range 3mm-37mm). 2D vs surgery comparisons of labral tear and RCT yielded poor agreements (Kappa= 0.26, 0.30) and RCT grade yielded fair agreement (ICC =0.43). 3D vs surgery comparisons of labral tear and RCT yielded good agreements (Kappa= 0.65, Kappa= 0.61 respectively) and tear grade yielded excellent agreement (ICC = 0.76).

3D MRI of the shoulder imore time-efficient with superior correlationto surgical findingthan 2D MRI. Single volume 3D isotropic MRI can suffice for cost-savingand better imaging interpretations.

The use of 3D reconstructions from 2D Dixon imaging has been explored in shoulder to better visualize bone injury and rotator cuff tear and shape characterization. However, use of isotropic 3D spin echo MRI, though described in knee MRI, has not been well-explored in the domain of shoulder imaging. Comparative evaluation of 2D versus 3D evaluation needs to be performed with surgical findings as the reference standard. If isotropic 3D MR imaging can provide equivalent or superior imaging information, a 6-7 minute 3D sequence could replace three plane 2D MR imaging (3 x 4min each).

When detecting subscapularis tendon tear, the diagnostic accuracy of magnetic resonance imaging (MRI) is low. Previous studies reported various indirect findings could help diagnose subscapularis tendon tear. The aim of the current study was to investigate which parameters on preoperative MRI was principal for predicting of subscapularis tendon tear requiring surgical repair.

Between July 2018 and June 2020, 86 patients who underwent arthroscopic rotator cuff repair were enrolled. On arthroscopic findings, 31(36%) patients had subscapularis tendon tear of Lafosse types III and IV and underwent surgical repair. Preoperative MR images were retrospectively reviewed for visual assessment of subscapularis tendon tear, long head of the biceps tendon (LHBT) pathology, posterior decentering (PD) of the humeral head, humeral rotation, fatty degeneration (Goutallier classification) and atrophy of the subscapularis muscle. Visual grading and thickness measurement were used for estimating atrophy, using anatomical line connecting the coracoid tip to the glenoid base designated as the base-to-tip line (BTL) in en-face view.

The sensitivity, specificity and accuracy of MRI for detecting subscapularis tendon tear were 48.4%, 87.3% and 73.3%, respectively. LHBT tear or subluxation (p=0.002), PD of the humeral head (p=0.012), fatty degeneration (p<0.001), and BTL grade (p=0.003) were significantly correlated with subscapularis tendon tear. On multivariate analysis, PD of the humeral head (p=0.011, OR=5.14) and fatty degeneration (p=0.046, OR=2.81) were independent predictors of subscapularis tendon tear. In patients without visible signal change at subscapularis tendon (n=64), PD of the humeral head show high sensitivity and specificity (81.3% and 75.0%, respectively) for predicting subscapularis tendon tear.

Among variable shoulder MRI parameters, PD of the humeral head and fatty degeneration could help diagnose clinically significant tear of subscapularitendon. During arthroscopy, it may be necessary to examine the subscapularitendon more precisely in patientwith PD of the humeral head or fatty degeneration on preoperative MRI.

Preoperative evaluation to detect subscapularis tendon tear is essential, because it is one of the risk factors for retear after rotator cuff tear repair. Our result show that posterior decentering of the humeral head and fatty degeneration were independent predictors of subscapularis tendon tear. These indirect signs may play an important role in surgical planning.

The purpose of this study was to design MRI reporting system of adhesive capsulitis of the shoulder joint (AC-MRS) by correlating the MRI findings of adhesive capsulitis with clinical findings and stage.

From January 2018 to November 2021, 223 patients diagnosed with adhesive capsulitis of the shoulder joint were included. We divided shoulder joint into superior and inferior parts, and the thickness and T2 hyperintensity of the capsules and pericapsular regions were scored respectively from 0 to 4. Patients were classified into 4 groups using degree of certainty, according to summed scores ranging from 0 to 16: >14 = AC-MRS 4 (highly probable); 10 to 13 = AC-MRS 3 (probable); 6 to 9 = AC-MRS 2 (possible); 3 to 5 = AC-MRS 1 (suspected). Presence of shoulder joint effusion in the axillary recess and the tendon sheath of long head biceps was additionally investigated. Then we analyzed the association of MRI scores with clinical features including clinical stage, pain intensity, limited range of motion and symptom duration.

25 (11.3%), 93(42.1%), 76 (34.4%), 26 (11.8%) patients were assigned to AC-MRS 4, AC-MRS 3, AC-MRS 2, AC-MRS 1 group in order. Most patients in AC-MRS 4 and 3 groups were in clinical stage 2 (80% and 65.6% respectively), and AC-MRS 4 showed no patient in clinical stage 3. AC-MRS showed significant correlation with limited ROM for forward flexion, abduction and external rotation (p <0.05). In particular, AC-MRS 4 showed severe (72.0%), moderate (24.0%), mild (4.0%) decrease in internal rotation on back (p <0.007).

AC-MRassessethe likelihood of adhesive capsulition MRI, which correlatewith limited ROM and symptom duration. It may have the potential to better describe MRI findingof adhesive capsulitis, predict clinical statuof each case and furthermore improve quality of care.

Adhesive capsulitis is a common shoulder disorder that is difficult to be accurately diagnosed by clinical criteria because many shoulder conditions have similar clinical symptoms. Clinical stages and MRI findings characteristic of adhesive capsulitis were reported. However, there has been lack of standardization of MRI data acquisition, interpretation, and reporting system.

The purpose of this study is to assess the predictive value of specific abnormal imaging appearance of the long head biceps tendon (LHBT) and surrounding structures in predicting abnormal surgical appearance of the biceps tendon on arthroscopy.

We retrospectively reviewed cases in which mild biceps tendinosis was described on imaging and who subsequently underwent shoulder arthroscopy. The LHBT was assessed for the degree and morphology of signal abnormality, caliber, dominant location of abnormal signal, and number of sagittal images with abnormal signal. Surrounding structures including the superior labrum, supraspinatus, and subscapularis tendons were also assessed. Evaluation was performed by two readers blinded to surgical findings, and joint interpretation was performed for variables with lower p values in the initial individual interpretation. Statistical analysis, including inter-reader agreement, multivariate wald chi square, univariate ANOVA, and sensitivity/specificity analysis was performed.

In total, 89 cases met inclusion criteria and were reviewed. 62 demonstrated pathology of the LHBT on arthroscopy. Interobserver agreement was moderate (kappa 0.41-0.60) for number of sagittal images with abnormal signal, supraspinatus tearing, degree of LHBT signal abnormality, globular biceps morphology, and a dominant location of groove entrance. No variables were significantly associated with arthroscopic LHBT pathology for both readers. On consensus analysis, the number of sagittal cuts with abnormal signal was significantly associated with the presence of arthroscopic LHBT pathology (p=0.047). Among the LHBT variables, sensitivity was highest for presence of abnormal signal on 4 or more sagittal images (41.2-43.8%) and specificity was highest for dominant location of biceps signal at the groove entrance (75.8-84.6%). A cut off of one abnormal LHBT feature yielded sensitivity of 66.7% and specificity of 72.3%, whereas a cut off of 4 abnormal LHBT features yielded lower sensitivity of 35.6-36.9% but higher specificity of 80.0-87.5. Among false positive cases, 14/27 (52%) demonstrated an appearance of linear non surfacing signal within a non expanded tendon at the mid intra-articular segment.

The imaging diagnosiof mild tendinosiof the LHBT doenot consistently correlate to tendon pathology on arthroscopy. Only the number of consecutive sagittal cutwith abnormal appearance of the tendon wasignificantly associated with abnormal surgical findings.

Mild tendinosis of the long head of the biceps tendon is commonly reported on MRI of the shoulder, but with significant overlap in appearance with normal biceps tendons.

To evaluate relationship of depth of the biceps groove and chronicity of long head biceps tendon tear.

The RIS database was searched for MR shoulder exams with complete biceps tear and multiple studies. Two reviewers measured biceps groove depth on initial and follow-up exams. A separate cohort of patients with chronic complete biceps tear or normal biceps on a single MR exam (single time-point) was also evaluated using T-test for analysis.

80 shoulder MR exams were evaluated in the single time-point cohort, with 40 chronic complete tears (average age 67.4, range 36-88) and 40 normal biceps tendons (average age 47.8, range 18-68). On exams with chronic tear, biceps groove depth averaged 3.29 mm (range, 0-6 mm). On exams with normal biceps, depth averaged 5.38 mm (range, 4-6 mm); T-test p= 0.0001. 26 shoulder MRIs with follow-up studies and complete tear on initial exam were reviewed (mean patient age 62, range 16-75). Biceps groove initially averaged 5.13 mm (range 4-8 mm), with depth of 2.21 mm on average 44 month follow-up (range 0-5 mm). All cases showed a measurable change in groove depth, including the shortest follow-up of 14 months (6 mm to 2 mm).

The bicipital groove appearto be reliant on presence of a tendon for preservation of itcharacteristic morphology. Complete tear of the long head bicepappearto result in gradual losof depth of the groove over time, with measurable changeevident in arapid aone year following tear.

Data suggest that this sign can be used to determine duration of a complete tear and whether the tendon is completely torn versus merely attenuated.