Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view.

Abstract

Imaging was performed on a 1.5-T MRI scanner (Signa Horizon LX, release 9.0, General Electric Medical Systems) with either the extremity coil or the dedicated shoulder phased array coil. In general, it was preferable for the patient to lie prone for these views. The shoulder was abducted 180°, with the arm beside the head. The elbow was flexed to 90°, with the forearm supinated, thumb up, and a shoulder phased array coil was placed around the elbow (Fig. 1). The position is referred to in this article as the flexed abducted supinated view, but usually in our practice it is termed the “FABS view,” meaning the flexed elbow with the shoulder abducted and the forearm in supination view. We initially performed a three-plane localizer, with either three or five images in the axial, sagittal, and coronal planes. The coronal localizer images (sagittal elbow anatomy) were used to plan the sequences along the long axis of the distal biceps brachii tendon (along the line of the tendon if it is visible). If the tendon was not clearly seen on the localizer images, the series was planned nearly perpendicular to the radius, which was always clearly seen (Fig. 2). The normal flexed abducted supinated view showed the full length of the tendon (Fig. 3). Images in axial, and in some cases sagittal, planes were then also obtained with the shoulder in abduction and the elbow extended in the overhead position. It is also possible to obtain the axial and sagittal images with the arm by the side. Series with and without fat suppression were performed (proton density fast spin echo; TR/TE, 3,000/34 or 45) along the axis of the tendon (elbow flexed) and axial to the elbow joint (elbow extended). The field of view was 15 × 15 cm, and the slice thickness was 3 or 4 mm with interslice spacing of zero. For the flexed abducted supinated view, usually 18 slices were obtained with an approximate examination time of 2 min 40 sec. Results The MR images were independently reviewed by two radiologists experienced in musculoskeletal imaging. We have imaged, using the flexed abducted supinated view, 21 symptomatic patients with possible distal biceps brachii tendon problem. In one case, both elbows were symptomatic and were imaged. These patients were 32‐81 years old (mean age, 52 years) and were imaged over the period from May 2001 to May 2003. Six asymptomatic healthy male volunteers (age range, 31‐48 years) were also imaged using both traditional sagittal and flexed abducted supinated positions. Three cases among 22 elbows in the study group exhibited normal distal biceps brachii tendons; in 14 cases, evidence of a partial tear or tendinosis of the distal biceps brachii tendon (Figs. 4 and 5) was present; in four cases, a complete tear (Fig. 6) was present; and in one case, an intact repaired complete tear was seen. In all cases, the full length of the biceps brachii tendon from musculotendinous junction to insertion on the radial tuberosity could be shown in one or, at most, two sections. In the 13 cases in which sagittal series were also performed, a single section less commonly ( n = 8) showed the full tendon in one or two sections. In four of these six asymptomatic volunteer evaluations, the flexed abducted supinated view showed the complete length of the tendon in one section; in the other two cases, it was seen in two sections. In the sagittal series of the healthy volunteers, the full tendon was seen in one section in only two cases.