Personal use only. MR Imaging Assessment of Rotator Cuff Muscle Quality
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1 MR Imaging Assessment of Rotator Cuff Muscle Quality Christian W. A. Pfirrmann Orthopedic University Hospital Balgrist University of Zurich Switzerland
2 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
3 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
4 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
5 Atrophy of Infraspinatus Infraspinatus tendon intact in all cases!
6 Atrophy of Infraspinatus Lesion of Suprascapular Nerve at Spinoglenoid Notch?
7 Suprascapular Nerve Suprascapular notch Spinoglenoid notch
8 Ganglion Spinoglenoid Notch
9 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
10 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis: Asymptomatic! Professional Beach Volleyball Athlete
11 Professional Beach Volleyball Athlete - in 30% of Pro Beach Volley Athletes - Weakness for ABD + ER - Asymptomatic! Cuff intact! - Speculative Mechanism: Traction injury of the suprascapular nerve caused by repetitive overhead hitting
12 Professional Beach Volleyball Athlete - Speculative Mechanism: Traction injury of the suprascapular nerve caused by repetitive overhead hitting
13 Beachvolleyball Grand Slam Klagenfurt
14 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
15 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis? Parsonage-Turner Syndrome
16 Parsonage-Turner Syndrome Involvement of suprascapular nerve: 97% of cases Gaskin CM, Radiology Aug;240(2):501-7
17 Parsonage-Turner Syndrome Parsonage-Turner syndrome = acute brachial neuritis and neuralgic amyotrophy Acute onset of severe shoulder pain Followed by weakness of at least one shoulder muscle The MR findings are thought to reflect denervation injury The diagnosis is suggested Abnormality of the muscles that are innervated by the brachial plexus No history of trauma or excessive overhead activity Other causes of high T2 signal intensity abnormality within muscle, such as myopathy, myositis, and tumor, also should be excluded Gaskin CM, Radiology Aug;240(2):501-7
18 Parsonage-Turner syndrome Involvement of Axillary Nerve: Teres minor and Deltoid Gaskin CM, Radiology Aug;240(2):501-7
19 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis?
20 Atrophy of Infraspinatus Infraspinatus Atrophy: Diagnosis: Full Thickness Supraspinatus tear with retraction
21 Full Thickness Tear of SSP
22 Supraspinatus Tear Infraspinatus muscle atrophy typically occurs with tendon tears in the anterior aspect of the rotator cuff. Concomitant atrophy in the supraspinatus muscle often is present, but infraspinatus muscle atrophy can occur in isolation, and this finding does not imply that the infraspinatus tendon is ruptured.
23 Suprascapular Nerve Retraction of the supraspinatus causes tension injury of the suprascapular nerve with denervation of the infraspinatus
24 Assessment of Muscle Quality Muscle atrophy after tendon tears is irreversible (Sheep, Rabbits, Rats, Humans) Preoperative assessment of muscle quality is crucial for outcome Muscle Quantity (Volume Atrophy) Muscle Quality (Fatty Infiltration)
25 50 16mm 22 32mm Meyer DC, J Orthop Res, 1004, 2004 Gerber, C., JBJS-A, 86-A(9): , 2004.
26 Muscle Quantity: Volume Pe rso Tangent Sign na l us eo nly Cross sectional area Volume Zanetti M, et al. Invest Radiol 1998 Kaick O, Acad Radiol. 2010
27 Muscle Quality: CT- Goutallier Grading Fatty Infiltration: Semi-quantitative Goutallier Grading Grade 1: Scattered areas of fat Grade 2: Fat < Muscle Grade 3: Fat = Muscle Grade 4: Fat > Muscle Developed for CT Goutallier D, et al CORR 1994:78-83.
28 Muscle Quality: MR - Goutallier Grading MR: Sagittal T1 or T2, NO Fat Sat Normal Scattered areas Fat < Muscle Fat = Muscle Fat > Muscle Reparable Irreparable Goutallier D, et al CORR 1994:78-83.
29 Use Non Fat Saturated Images T1w T2w Fat Sat
30 Muscle Quality: Reliability of CT and MR? Interobserver reproducibility for grading fatty infiltration is good to excellent for CT and for MRI. The correlation between MRI and CT is only fair to moderate Is there a more reliable method to quantify fatty infiltration? Fuchs B, et al. JSES 1999 Nov-Dec;8(6):.
31 CT: Gray Scale for Grading Fat Content? Bone Window Soft Tissue Window
32 CT: Hounsfield Unit Tissue HU Bone Muscle + 10 to + 40 Water 0 Fat - 50 to Air
33 MR: Signal Intensity for Grading Fat Content?
34 MR: Signal Intensity for Grading Fat Content? Distance to coil determines signal
35 H+-Spectroscopy: Muscle Quality MRS offers the possibility to quantify the lipid content of muscle. 2 major lipid peaks: intramyocellular lipid (IMCL) extramyocellular lipid (EMCL) Optimal at higher field strength (3Tesla) Cr2, creatine and/or phosphocreatine-ch2 TMA, trimethylammonium X3 taurine Cr3, creatine and/or hosphocreatine-ch3; EMCL, extramyocellular lipids IMCL, intramyocellular lipids Before Marathon Boesch C, PNS (1999), 58 After Marathon
36 H+-Spectroscopy: Muscle Quality Quantitative: H + -Spectroscopy Pfirrmann C, Radiology Sep;232(3):709-15
37 H+-Spectroscopy: Muscle Quality Lipid Content vs T1w Appearance Grade % (CI: 16.7% %) Grade % (CI: 33.9% %) Grade % (CI: 40.2% %) Grade % (CI: 44.7% %) Grade % (CI: 67.1% %) Pfirrmann C, Radiology Sep;232(3):709-15
38 H+-Spectroscopy: Muscle Quality Proton MR spectroscopy is able to depict fatty muscle changes before they become visible on standard MR images. Pfirrmann C, Radiology Sep;232(3):709-15
39 Dixon Technique for Fat Quantification Fischer MA; Eur Radiol (2014) 24:
40 Dixon Technique for Fat Quantification Water Image Fat Image H Spectroscopy Calculation of Fat % Map
41
42 Dixon: Quantification of Low Levels of Fat SSP 1 = no tear, 2 = partial tear, 3 = full-thickness tear. Agten C, Eur Radiol 2015
43 Acoustic Radiation Force Impulse (ARFI)
44 US-Elastography Elastography: Muscle Tissue Rosskopf AB, Radiology 2016
45 US-Elastography Mean total shear wave velocity Goutallier0 Goutallier 1 Goutallier 2 Goutallier 3 Goutallier 4 Rosskopf AB, Radiology 2016
46 US-Elastography Rosskopf AB, Radiology 2016
47 Quantitative Imaging of the Shoulder Signal and Artefact
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