Adhesive Capsulitis - Frozen Shoulder - MRI features

68 year old with gradual increasing restriction of right shoulder movements with shoulder pain.

MRI demonstrates:

Inferior glenohumeral ligament and the inferior joint capsule (yellow block arrow) in the axillary recess shows diffuse thickening.

Diffuse thickening of the coracohumeral ligament (white arrow) extending upto the rotator cuff interval and is hyperintense on the T2 images.

Appearances are indicative of features of adhesive capsulitis.

Adhesive Capsulitis:

Adhesive capsulitis or frozen shoulder is an inflammatory condition of the glenohumeral joint synovium and capsule leading to a restricted range of motion.

 - most commonly encountered in female patients who are 40 to 60 years of age. 

 - abnormalities most commonly involve the rotator interval capsule, the biceps tendon root, and the inferior and posterior capsule.

 - clinical features of rotator cuff pathology and impingement often mimic those of adhesive capsulitis.

Rotator interval lies between the supraspinatus muscle and tendon posterosuperiorly and the subscapularis muscle and tendon anteroinferiorly. 

Coracohumeral ligament is readily identified on sagittal and coronal T1-weighted or T2-weighted  images as a curvilinear low-signal structure surrounded by fat, lateral to the coracoid process.

 The thickness of the capsule of the axillary recess is best demonstrated on coronal images at the mid glenoid level

MRI findings that suggest adhesive capsulitis:

- soft tissue thickening in the rotator interval, which may encase the coracohumeral and superior glenohumeral ligaments, and soft tissue thickening adjacent to the biceps anchor . 

 - thickened inferior glenohumeral ligament greater than 4 mm is often seen in the axillary pouch

Reference:

http://www.radsource.us/clinic/0502

Infantile Scalp Hemangioma - MRI features

3 month old with scalp swelling

Well delineated subcutaneous scalp mass ( block arrow)  in the left parasagittal frontoparietal region that shows intermediate to high signal on T1 and T2 images with linear flow voids (small arrow heads). No intracranial extension.

MRI is usually performed to characterize the swelling and to exclude intracranial extension.

Isolated hypoglossal nerve palsy due to a tortuous vertebral artery course -MRI features

42 year old man presenting with difficulty in speech and deviation of the tongue to the left. MRI was performed to assess for organic cause.


Axial 3D SPACE

Axial T1

Coronal STIR

MRI showed a demonstrated a tortuous left vertebral artery compressing the medulla at the emergence of the left hypoglossal nerve rootlets.


On the coronal STIR images there is atrophy of the left half of  the tongue which appears reduced in bulk and minimally hyperintense compared to the right.


Microvascular decompression of the vertebral artery can result in resolution of the nerve palsy. 

Os acromiale - mesoacromion -symptomatic - MRI features

27 year old female patient with left shoulder pain. No history of trauma.

Coronal Oblique PDFS

Axial T1

MRI shows presence of os acromiale with hyperintense signal seen at the synchondrosis on the PDFS images indicative of edema which could be the cause of the pain.

There was no evidence of secondary rotator cuff impingement.

MRI shows presence of os acromiale with hyperintense signal seen at the synchondrosis on the STIR images indicative of edema which could be the cause of the pain.

Os acromiale:

• results from failure of an anterior acromial ossification center to fuse to the  acromial process

• caused by failure of one of three ossification centers; 

• ossification centers appear at age 15 and should fuse by age 22-25. 

• subtypes: (from anterior to posterior)

             -  preacromion, mesacromion, metacromion, and basiacromion types; 

              - mesacromion and metacromion are most common; 

• patients may show impingement like symptoms but will also have 

           localized tenderness.

Fibula Stress Fracture - MRI features

25 year old badmintom player complaining of pain along the lateral aspect of the left leg:

Axial STIR

Axial T2

                               

Coronal T1

Sagittal T1

Diffuse periosteal thickening is seen along the lateral cortex of the distal fibular shaft with hyperintense signal on T2 and STIR images (arrows) and hyperintense signal of the adjacent intramedullary marrow.

In the midst of the marrow hyperintensity there is a subtle horizontal linear low signal seen best on coronal T1 and sagittal T1 images (arrow) indicative of a fracture line.

There is associated surrounding soft tissue edema.

Appearances  represent a distal fibular stress fracture .

Fibular fractures account for 10% of the stress fractures and are commonly seen in the distal two thirds. 

MRI in neck imaging This is a power point presentation about MRI in Neck.Initial few slides are about anatomy of neck.Later cases.Cases are about MR sialogram , carotid body tumor , infiltrating nasopharyngeal carcinoma , vocal cord palsy , neurogenic tumor and CT versus MRI in neck imaging. 

Contributed by Dr Krishna Kiran

Large Sessile Osteochondroma Of The Lesser Trochanter Of Femur - MRI features

Osteochondroma 

- most common bone tumor

- developmental lesion rather than a true neoplasm. 

- 20%–50% of all benign bone tumors and 10%–15% of all bone tumors.

- composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. 

- Complications  - deformity, fracture, neurovascular compromise, overlying bursa formation, and malignant transformation

- Malignant transformation is seen in 1% of solitary osteochondromas. Continued lesion growth and a hyaline cartilage cap greater than 1.5 cm in thickness, after skeletal maturity, suggest malignant transformation. 

MRI of the osteochondroma (grey solid arrow) is the best radiologic modality for visualizing the effect of the lesion on surrounding structures and evaluating the hyaline cartilage cap. 

High water content in nonmineralized portions of the cartilage cap shows intermediate to low signal intensity on T1-weighted images and very high signal intensity on T2-weighted MR images ( yellow pentagon).

MRI allows accurate measurement of the cartilage cap thickness and distinction from overlying muscle on MR images. 

References:

 Murphey MD et al :Imaging of Osteochondroma: Variants and Complications with Radiologic-Pathologic Correlation - Radiographics September 2000 20:5 1407-1434

http://radiographics.rsna.org/content/20/5/1407.full