MRI of Chest and Shoulder Joint PDF

MRI of chest and shoulder joint Dr.Hayder Jasim Taher PhD of Medical Imaging Outline of my presentation Patient preparation and safety. Precautions. Contrast media. A -Positive relaxation agents (T1 agents). B -Negative rel...

MRI of chest and shoulder joint Dr.Hayder Jasim Taher PhD of Medical Imaging Outline of my presentation Patient preparation and safety. Precautions. Contrast media. A -Positive relaxation agents (T1 agents). B -Negative relaxation agents (T2 agents). Gadolinium.  Anatomical overview The chest or thorax is the region of the bony thoracic cage located between the neck and abdomen. The upper boundary of the chest, the thoracic inlet, is formed by the first thoracic vertebra, the first ribs, and the upper margin of the manubrium. Inferiorly, the chest extends to the level of the thoracic outlet, marked by the diaphragm, which extends between the inferior margin of the sternum and the upper lumbar vertebra.  Common indications 1-Mediastinal mass, e.g. lymphoma and congenital cyst. 2-Neurogenic lesions, e.g. thoracic meningoceles and malignant nerve sheath tumors. 3-Differentiation between lymph nodes and vascular anomalies. 4-Assessment of vascular anomalies of chest (in conjunction with MRA), e.g. thoracic aortic aneurysms.  MRI Procedure Patient position: 1- Patient should be in supine- position (head first). Patients who suffer from claustrophobia may prefer a feet-first orientation. 2- Set-up the coil (Torso-array coil).  MRI Procedure Scout slice placement: 1-Coronal localizer for axial slice - Alignment: True axial. - Coverage: A-Superior to inferior: Thoracic inlet to diaphragmatic crura. B- Lateral to medial: Chest wall on each side. C-Posterior to anterior: Thoracic spinous processes to sternum. - Axial slices are used to demonstrate the following: 1-Contents of mediastinum. 2-Morphology of the great vessels and heart.  MRI Procedure 2-Axial localizer for coronal slice -Alignment: True coronal. - Coverage: As for axial plane. - It is the best plane for demonstrating the costophrenic angles and lung apices. MRI Procedure  Anatomical overview The shoulder joint is formed by an articulation between the head of the humerus and the glenoid cavity (or fossa) of the scapula. This gives rise to the alternate name for the shoulder joint – the glenohumeral joint. The head of the humerus is much larger than the glenoid fossa, giving the joint a wide range of movement at the cost of instability. To reduce the disproportion in surfaces, the (Fig.1) The articulating glenoid fossa is deepened by a surfaces of the shoulder  Indications of shoulder joint MRI: 1-Diagnosis and evaluation of impingement syndrome and instability. 2-Sometimes useful in the evaluation of frozen shoulder syndrome. 3-Rotator cuff injury. 4-Pectoralis tear.  MRI procedure (shoulder joint) Patient position: 1- Position the patient supine, head first. Offset the patient left or right and bring the shoulder as close as possible to magnet isocenter. To help minimize motion, oblique the patient, shoulder of interest down. 2- Set-up the multi-channel shoulder coil. 3- Recheck the straps to make sure they are secure to ensure immobilization of the Fig-2 patient position patient. (shoulder joint MRI) Fig-2  MRI procedure (shoulder joint) Scout slice placement: - 1-Coronal localizer to obtain axial slice. -Alignment: Usually true axial. If the humeral head is sitting in an abnormally high position, some angulation to the supraspinatus muscle may be required. - Coverage: From above acromioclavicular joint through surgical neck of humerus. - Slice Acquisition: Superior to inferior.  MRI procedure (shoulder joint) 2-Axial localizer to obtain sagittal slice -Slice acquisition: Lateral to medial. - Slice alignment: Parallel to the glenoid fossa. - Anatomic coverage: Entire deltoid muscle through glenoid fossa.  MRI procedure (shoulder joint) 3-Axial localizer to obtain coronal slice -Slice acquisition: Anterior to posterior. -Slice alignment: Perpendicular to the glenoid fossa, parallel to supraspinatus muscle. -Anatomical coverage: Subscapularis muscle through the supraspinatus tendon. MRI Sequences (Shoulder joint) Thank