Artrografia RM (Ressonância Magnética) do ombro: anatomia normal da articulação glenoumeral e manguito rotador em IRM

Artrografia RM (Ressonância Magnética) do ombro: anatomia normal da articulação glenoumeral e manguito rotador em IRM

Artrografia RM (Ressonância Magnética) do ombro: anatomia normal da articulação glenoumeral e manguito rotador em IRM


Este módulo e-Anatomy é dedicado à anatomia do ombro e do manguito rotador em uma artrografia em RM.

Esta artrografia por ressonância magnética do ombro foi realizada em um paciente do sexo masculino IRM GE Signa Pioneer 3T MRI pelo Dr. Corey Chakarun da Shin Imaging na Califórnia. Este exame não está dentro da normalidade devido a uma lesão crônica do complexo labroligamentar ântero-inferior glenoideo.

Uma injeção de 12ml de solução de gadolínio (diluição 1: 200) foi aplicada na articulação do ombro através de uma fluoroscopia, com abordagem posterior (paciente em decúbito dorsal com o ombro em discreta rotação externa).

Em seguida, esta RM foi realizada com o ombro em posição neutra (exceto a ABER), com 5 sequências diferentes comumente usadas em artrografia por RM da articulação do ombro: 

  • Axial T1-weighted fat saturation
MR Arthrography of the shoulder in Axial T1 FS: Normal anatomy of the glenohumeral joint and of the rotator cuff. This MRI shows the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa
Axial T1 FS image shows the normal anatomy of the glenohumeral joint and the rotator cuff on a MR (Magnetic Resonance) arthrography of the shoulder. On this MRI the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa can be distinguished.

 

  • Oblique coronal T1-weighted fat saturation
Shoulder MR arthrogram on coronal F1 FS showing the anatomy of the normal glenohumeral joint and of the rotator cuff
This oblique coronal T1-weighted fat saturation image shows the anatomy of the normal glenohumeral joint and of the rotator cuff

 

  • Oblique coronal PD-weighted fat saturation
Shoulder MR Arthogram in coronal PD FS showing the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
This oblique coronal PD-weighted fat saturation image shows the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa

 

  • Oblique sagittal T1-weighted FSE
Shoulder MR arthrogram on sagittal T1 showing the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the glenohumeral ligaments
This oblique sagittal T1-weighted FSE image shows the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the lenohumeral ligaments

 

  • T1-weighted fat saturation in abduction and external rotation (ABER)
Shoulder MR arthrogram in the ABER position-T1 FS: the glenohumeral joint, the shoulder joint, the supraspinatus tendon, the glenoid labrum can be distinguished
This T1-weighted fat saturation was performed in abduction and external rotation (the ABER position). It shows the glenohumeral joint, the shoulder joint, the supraspinatus tendon and the glenoid labrum

 

As estruturas anatômicas foram legendadas nestas imagens de ressonância magnética pelos Drs. Antoine Micheau e Denis Hoa, utilizando a nova Terminologia Anatomica (TA2 - 2020) e alguns termos usados na rotina clínica para a anatomia radiológica do ombro foram adicionados.

MR Arthrography of the shoulder in Axial T1 FS: Normal anatomy of the glenohumeral joint and of the rotator cuff. This MRI shows the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa
Figura 1 - Axial T1 FS image shows the normal anatomy of the glenohumeral joint and the rotator cuff on a MR (Magnetic Resonance) arthrography of the shoulder. On this MRI the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa can be distinguished.
Shoulder MR arthrogram on coronal F1 FS showing the anatomy of the normal glenohumeral joint and of the rotator cuff
Figura 2 - This oblique coronal T1-weighted fat saturation image shows the anatomy of the normal glenohumeral joint and of the rotator cuff
Shoulder MR Arthogram in coronal PD FS showing the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
Figura 3 - This oblique coronal PD-weighted fat saturation image shows the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
Shoulder MR arthrogram on sagittal T1 showing the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the glenohumeral ligaments
Figura 4 - This oblique sagittal T1-weighted FSE image shows the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the lenohumeral ligaments
Shoulder MR arthrogram in the ABER position-T1 FS: the glenohumeral joint, the shoulder joint, the supraspinatus tendon, the glenoid labrum can be distinguished
Figura 5 - This T1-weighted fat saturation was performed in abduction and external rotation (the ABER position). It shows the glenohumeral joint, the shoulder joint, the supraspinatus tendon and the glenoid labrum
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  • The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale - Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11–21. doi:10.1007/s13244-011-0129-9
  • Transverse Thickening Along the Articular Surface of the Rotator Cuff Consistent With the Rotator Cable: Identification With MR Arthrography and Relevance in Rotator Cuff Evaluation. Kenneth Sheah, Miriam A. Bredella, Jon J. P. Warner, Elkan F. Halpern, and William E. Palmer American Journal of Roentgenology 2009 193:3, 679-686
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