Gadolinium MR Arthrography of the Rotator Cuff

Abstract

Conventional magnetic resonance imaging (MRI) of the rotator cuff has not done well in distinguishing partial-thickness tears from tendonitis or small, full-thickness tears. However, these are important distinctions for orthopedic surgeons who are deciding whether to operate and what type of surgery to perform on a patient with suspect rotator cuff pathology. Gadolinium magnetic resonance arthrography (MRA) involves injecting dilute gadolinium into the shoulder under fluoroscopy. Subsequent multiplanar T1-weighted fat-suppressed fast spin echo combined with T2-weighted fast spin echo and short tau inversion recovery (STIR) produces images that can accurately differentiate absence of tear from partial-thickness tear and from small, full-thickness tear; as a fringe benefit, this combination of sequences can identify the inflammation associated with tendonitis. Furthermore, the technique differentiates articular from bursal surface partial-thickness tears, and it accurately quantitates the size of full-thickness tears to help surgeons choose between arthroscopic versus open surgery.