they remain electrically isolated from each other. Although MRI scanners can handle as many as 8 or 16multicoil array channels,currently most shoulder array coils are four-channel arrays (Fig.99-1).Shoulder multicoil arrays will permit imaging with high resolution,small ﬁelds of view,and thin sections.
Pulse Sequences and Parameters
Conventional spin-echo sequences have for the mostpart been replaced in MRI by fast spin-echo imagingsequences.Short repetition time (TR)/time to echo (TE)images are still,however,helpful to demonstrateanatomic details and are most often used in MR arthrography.The tissue contrast is similar in fast spin-echo imagingsequences to that seen with conventional spin echo;however,fat is more intense on T2-weighted fast spin-echo images,and therefore differentiating fat from ﬂuidsignal can sometimes be difﬁcult.Blurring of anatomicstructures is another problem,especially on short TEsequences.Comparative studies have established theefﬁcacy of fast spin-echo techniques.
Since marrow fatis brighter,marrow edema can be obscured and ﬂuid intears or in effusions may be more difﬁcult to identify.Thus most commonly,fat-suppression techniques areadded.Gradient-echo sequences
may be applied inimaging the shoulder.These techniques can be used for kinematic imaging
and are also used to evaluate theglenoid labrum.Problems with the gradient-echotechnique include the vacuum phenomenon,
which may simulate loose bodies or calciﬁcation,and increasedmagnetic-susceptibility artifact.Fat suppression is useful in shoulder MRI as it canincrease the conspicuity of an abnormality.This effectismost prominent on T2-weighted sequences.Detec-tionof abnormal enhancement after contrast injectionisimproved on T1-weighted images by using fat sup-pression.TR and TE can also be reduced on T2-weightedfast spin-echo sequences without loss of tissue contrast,and imaging sequences with TEs in the 35 to 45 ms rangeare often used with fat saturation in place of imag-ingsequences with longer TEs and poorer SNR.Fatsuppression also reduces phase-encoding and chemicalshift artifacts.The two most common types of fat sup-pression are short tau inversion recovery (STIR) imagingand fat saturation.STIR images exhibit combined T1 andT2 contrast,which enhance sensitivity but diminish speciﬁcity.Fat saturation uses a radiofrequency pre-saturation pulse applied at the resonant frequency of lipid protons,followed by a gradient pulse designed tospoil any residual signal intensity of fat.This technique isbetter with high ﬁeld-strength systems and a highly uniform magnetic ﬁeld.
Methods such as STIR and fat-saturation T2 can improve visualization of rotator cuff tendon injuries (Fig.99-2) and hyaline cartilage lesions,and are also used to evaluate marrow abnormalities,andinﬂammatory and post-traumatic processes.They may also be useful to evaluate labral tears.Performance of high-resolution imaging using largematrices has recently become available,with systemscapable of performing 512
512 matrices,or usingparallel imaging,3-T magnets,and appropriate coils evenhigher matrices may be employed (Fig.99-3).Thesetechniques may improve visualization of subtle abnor-malities involving the labrum and rotator cuff.Smaller ﬁelds of view
are also helpful in the evaluation of theshoulder.Large matrix and/or small ﬁeld of view imagingis made possible by higher ﬁeld strength,improvementsin scanner hardware,better local coils,or such standardfactors as increased excitations and longer repetitiontime.A narrow receiver bandwidth also improves SNR.The slice thickness is also an important determinantof spatial resolution.Slice thicknesses of 2 mm on two-dimensional (2D) spin- and gradient-echo sequencesandthicknesses of 1mm or less on 3D Fourier transform(FT) images are available on most scanners for routineusage.These are also very useful for evaluating such
C H A P T E R
F I G U R E 99-1
Four-channel array coil consisting of four linear coils arranged in a strip. The arrows represent theB1 ﬁeld of each coil in the array.
Four-channel array shoulder coil positioned on a normal volunteer. Patients areimaged in a supine position, with their arm by the side in the neutral rotation.
(Courtesy of Tom Schubert, MRIDevices Corporation, Waukesha, WI