333 MR Imaging of the Shoulder: Diagnosis of Rotator Cuff Tears J. Bruce Kneeland1 Williarn 0. Middleton1 Guillermo F. Carrera1 Robert C. Zeuge2 Andrzej Jesrnanowicz1 Wojciech Froncisz1 Jarnes S. Hyde1 Received January 28, 1987; accepted after re- vision April 3, 1987. This work was supported in part by NIH grants ARO1 088 and CA41 464 and a grant from General Electric Medical Systems. 1 Department of Radiology, Medical College of Wisconsin, MilwaukeeWl. Address reprint requests to J. B. Kneeland, Dept. of Radiology, Milwaukee County Medical Complex, 8700 W. Wisconsin Ave., Milwaukee, WI 53226. 2 of Orthopedic Surgery, Columbia Hospital, 3321 N. Maryland Ave., Milwaukee, WI 53211. AJR 149-.333-337, August 1987 0361 -803x/87/1492-0333 C American Roentgen Ray Society Twenty-five patients with known or suspected tears of the rotator cuff in 26 shoulders underwent MR imaging. All patients also underwent arthrography or surgery. MR visu- alized abnormalities consistent with a tear In 20 of the 22 tears diagnosed by arthrog- raphy or surgery. In most cases, tears were seen as regions of increased signal intensity within the cuff on Iong-TR pulse sequences, although two cases simply showed an almost complete absence of normal cuff. The MR appearance of the two cases with partial tears was similar to that of full-thickness tears. Of the four cases with normal arthrograms, one case had MR findings consistent with a tear. We conclude that MR has good potential for the noninvasive diagnosis of rotator cuff tears. Its ultimate role in this diagnosis must await prospective studies comparing its accuracy with that of sonography, CT, and arthrography. The rotator cuff consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles together with their tendons. Rotator cuff tears are both common and important [1]. The radiologic diagnosis of rotator cuff tears has traditionally been performed with arthrography and more recently with sonography [2-4] with CT [5]. Arthrog- raphy is quite accurate in detecting complete tears, but it is an invasive procedure with some associated risk and discomfort [6]. In addition, arthrography is insensitive to partial tears involving the superficial surface or the substance of the cuff. It will only detect tears involving the deep surface [7]. Sonography is noninvasive and has an accuracy similar to that of arthrography for the diagnosis of tears [2J. However, it is highly operator-dependent, requires a dedicated small-parts trans- ducer, and is incapable of visualizing portions of the cuff beneath the acromion [2]. Postarthrography CT, although more sensitive to the presence of partial tears than arthrography, entails the same risk and discomfort [5]. MR imaging with surface coils has proved of great value in the assessment of disorders of the peripheral joints [8-1 1]. In previous papers, we presented a detailed correlation between MR and cryomicrotome sections of the rotator cuff [1 2] and the preliminary results of imaging a small number of patients with known rotator cuff tears using a novel coil design [1 3]. In this paper, we present the results of MR imaging of 25 patients with suspected rotator cuff tears on whom arthrography or surgery was performed. Materials and Methods Twenty-five patients (1 5 men, 10 women; ages, 24-67) with the clinical signs and symptoms of rotator cuff tears underwent MR imaging of either one (24) or both (one) shoulders. Thus, in total, 26 shoulders were imaged. Arthrography was performed on 24 of 26 shoulders within 30 days of the MR examination. In the other two cases no arthrograms were obtalned but surgery was performed within 30 days. MR imaging was performed on a Signa MR system (General Electric) operating at 1 .5 T. An angled pair of 7.5-cm diameter, counter-rotating current-Ioop-9ap resonators were used Downloaded from www.ajronline.org by 18.206.13.133 on 06/11/20 from IP address 18.206.13.133. Copyright ARRS. For personal use only; all rights reserved