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The Impact of MR Imaging in Sports Medicine¹

¹ From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710. Received January 16, 2002; revision requested January 28; revision received February 20; accepted March 13. Address correspondence to the author (e-mail: helms002@mc.duke.edu).

View larger version (121K): [in a new window]   Figure 1. Peripheral meniscal tear. Sagittal spin-echo intermediate-weighted fat-suppressed MR image (repetition time msec/echo time msec, 2,000/20) through the medial meniscus shows a peripheral tear (arrow) with a rim less than 2 mm thick. This is a meniscal tear that should be considered for repair.

View larger version (149K): [in a new window]   Figure 2a. Posterolateral corner injury. (a) Sagittal spin-echo intermediate-weighted MR image (2,000/20) through the intercondylar notch shows a thickened posterior cruciate ligament (arrows) with intermediate signal intensity throughout, indicative of a torn posterior cruciate ligament. (b) Coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) reveals a torn medial collateral ligament (arrow). (c) Transverse fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) at the level of the joint shows the posterior capsule (straight arrow) of the medial side of the joint, which is not evident on the lateral side. This indicates a torn arcuate ligament (which should be seen as a thickening of the lateral capsule at the joint line). In addition, the popliteus tendon (curved arrow) has high signal intensity within and a distended tendon sheath. (d) Transverse fast spin-echo T2-weighted MR image (3,000/70) several centimeters distal to the joint shows high signal intensity surrounding the popliteus muscle (arrow), indicative of injury. At surgery, the popliteus muscle was torn at the musculotendinous junction, and the posterior cruciate, medial collateral, and arcuate ligaments were torn.

View larger version (153K): [in a new window]   Figure 2b. Posterolateral corner injury. (a) Sagittal spin-echo intermediate-weighted MR image (2,000/20) through the intercondylar notch shows a thickened posterior cruciate ligament (arrows) with intermediate signal intensity throughout, indicative of a torn posterior cruciate ligament. (b) Coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) reveals a torn medial collateral ligament (arrow). (c) Transverse fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) at the level of the joint shows the posterior capsule (straight arrow) of the medial side of the joint, which is not evident on the lateral side. This indicates a torn arcuate ligament (which should be seen as a thickening of the lateral capsule at the joint line). In addition, the popliteus tendon (curved arrow) has high signal intensity within and a distended tendon sheath. (d) Transverse fast spin-echo T2-weighted MR image (3,000/70) several centimeters distal to the joint shows high signal intensity surrounding the popliteus muscle (arrow), indicative of injury. At surgery, the popliteus muscle was torn at the musculotendinous junction, and the posterior cruciate, medial collateral, and arcuate ligaments were torn.

View larger version (146K): [in a new window]   Figure 2c. Posterolateral corner injury. (a) Sagittal spin-echo intermediate-weighted MR image (2,000/20) through the intercondylar notch shows a thickened posterior cruciate ligament (arrows) with intermediate signal intensity throughout, indicative of a torn posterior cruciate ligament. (b) Coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) reveals a torn medial collateral ligament (arrow). (c) Transverse fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) at the level of the joint shows the posterior capsule (straight arrow) of the medial side of the joint, which is not evident on the lateral side. This indicates a torn arcuate ligament (which should be seen as a thickening of the lateral capsule at the joint line). In addition, the popliteus tendon (curved arrow) has high signal intensity within and a distended tendon sheath. (d) Transverse fast spin-echo T2-weighted MR image (3,000/70) several centimeters distal to the joint shows high signal intensity surrounding the popliteus muscle (arrow), indicative of injury. At surgery, the popliteus muscle was torn at the musculotendinous junction, and the posterior cruciate, medial collateral, and arcuate ligaments were torn.

View larger version (142K): [in a new window]   Figure 2d. Posterolateral corner injury. (a) Sagittal spin-echo intermediate-weighted MR image (2,000/20) through the intercondylar notch shows a thickened posterior cruciate ligament (arrows) with intermediate signal intensity throughout, indicative of a torn posterior cruciate ligament. (b) Coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) reveals a torn medial collateral ligament (arrow). (c) Transverse fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) at the level of the joint shows the posterior capsule (straight arrow) of the medial side of the joint, which is not evident on the lateral side. This indicates a torn arcuate ligament (which should be seen as a thickening of the lateral capsule at the joint line). In addition, the popliteus tendon (curved arrow) has high signal intensity within and a distended tendon sheath. (d) Transverse fast spin-echo T2-weighted MR image (3,000/70) several centimeters distal to the joint shows high signal intensity surrounding the popliteus muscle (arrow), indicative of injury. At surgery, the popliteus muscle was torn at the musculotendinous junction, and the posterior cruciate, medial collateral, and arcuate ligaments were torn.

View larger version (156K): [in a new window]   Figure 3a. Abnormal cartilage demonstrated with different MR imaging sequences. (a) Sagittal spin-echo T2-weighted image (2,000/80) shows subtle cartilage abnormality (arrow) in the lateral femoral condyle. (b) Sagittal three-dimensional volume spoiled gradient-echo fat-suppressed image (60/5; flip angle, 40°) through the same area as in a shows the articular cartilage to have marked high signal intensity with smooth margins, while abnormal cartilage (arrow) has low signal intensity. (c) Coronal fast spin-echo T2-weighted image (3,000/70) in the same patient shows the cartilage defect (arrow) in the lateral femoral condyle.

View larger version (154K): [in a new window]   Figure 3b. Abnormal cartilage demonstrated with different MR imaging sequences. (a) Sagittal spin-echo T2-weighted image (2,000/80) shows subtle cartilage abnormality (arrow) in the lateral femoral condyle. (b) Sagittal three-dimensional volume spoiled gradient-echo fat-suppressed image (60/5; flip angle, 40°) through the same area as in a shows the articular cartilage to have marked high signal intensity with smooth margins, while abnormal cartilage (arrow) has low signal intensity. (c) Coronal fast spin-echo T2-weighted image (3,000/70) in the same patient shows the cartilage defect (arrow) in the lateral femoral condyle.

View larger version (159K): [in a new window]   Figure 3c. Abnormal cartilage demonstrated with different MR imaging sequences. (a) Sagittal spin-echo T2-weighted image (2,000/80) shows subtle cartilage abnormality (arrow) in the lateral femoral condyle. (b) Sagittal three-dimensional volume spoiled gradient-echo fat-suppressed image (60/5; flip angle, 40°) through the same area as in a shows the articular cartilage to have marked high signal intensity with smooth margins, while abnormal cartilage (arrow) has low signal intensity. (c) Coronal fast spin-echo T2-weighted image (3,000/70) in the same patient shows the cartilage defect (arrow) in the lateral femoral condyle.

View larger version (107K): [in a new window]   Figure 4a. SLAP lesion in a professional baseball pitcher. (a, b) Consecutive oblique coronal T1-weighted fat-suppressed MR arthrograms (600/20) show gadolinium-based contrast material entering the torn superior labrum (arrow), which was present on multiple images, indicating a SLAP tear. The tear was confirmed at arthroscopy (not shown).

View larger version (118K): [in a new window]   Figure 4b. SLAP lesion in a professional baseball pitcher. (a, b) Consecutive oblique coronal T1-weighted fat-suppressed MR arthrograms (600/20) show gadolinium-based contrast material entering the torn superior labrum (arrow), which was present on multiple images, indicating a SLAP tear. The tear was confirmed at arthroscopy (not shown).

View larger version (167K): [in a new window]   Figure 5a. Parsonage-Turner syndrome (acute brachial neuritis). (a) Oblique coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/63) shows marked high signal intensity throughout the supraspinatus muscle (S) and in the deltoid muscle (arrow). (b) Oblique sagittal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) (anterior to the left) shows that in addition to the high signal intensity in the supraspinatus and deltoid muscles, the infraspinatus and teres minor (arrow) muscles are involved. This diffuse edema pattern is characteristic of a neurogenic deficit involving both suprascapular and axillary nerves.

View larger version (163K): [in a new window]   Figure 5b. Parsonage-Turner syndrome (acute brachial neuritis). (a) Oblique coronal fast spin-echo T2-weighted fat-suppressed MR image (3,000/63) shows marked high signal intensity throughout the supraspinatus muscle (S) and in the deltoid muscle (arrow). (b) Oblique sagittal fast spin-echo T2-weighted fat-suppressed MR image (3,000/70) (anterior to the left) shows that in addition to the high signal intensity in the supraspinatus and deltoid muscles, the infraspinatus and teres minor (arrow) muscles are involved. This diffuse edema pattern is characteristic of a neurogenic deficit involving both suprascapular and axillary nerves.

View larger version (173K): [in a new window]   Figure 6. Quadrilateral space syndrome. Oblique sagittal spin-echo T1-weighted MR image (600/20) (anterior to the left) shows marked fatty atrophy involving the teres minor muscle (arrow), indicative of quadrilateral space syndrome.

View larger version (150K): [in a new window]   Figure 7a. Suprascapular nerve entrapment. Oblique coronal (a) spin-echo intermediate-weighted (2,000/20) and (b) fast spin-echo T2-weighted (3,000/70) MR images through the shoulder show a ganglion (arrow) in the spinoglenoid notch of the scapula. (c) Oblique coronal sagittal T2-weighted fat-suppressed fast spin-echo MR image (3,000/70) shows edema in the infraspinatus muscle (arrow) secondary to impingement of the suprascapular nerve by the ganglion in the spinoglenoid notch.

View larger version (161K): [in a new window]   Figure 7b. Suprascapular nerve entrapment. Oblique coronal (a) spin-echo intermediate-weighted (2,000/20) and (b) fast spin-echo T2-weighted (3,000/70) MR images through the shoulder show a ganglion (arrow) in the spinoglenoid notch of the scapula. (c) Oblique coronal sagittal T2-weighted fat-suppressed fast spin-echo MR image (3,000/70) shows edema in the infraspinatus muscle (arrow) secondary to impingement of the suprascapular nerve by the ganglion in the spinoglenoid notch.

View larger version (162K): [in a new window]   Figure 7c. Suprascapular nerve entrapment. Oblique coronal (a) spin-echo intermediate-weighted (2,000/20) and (b) fast spin-echo T2-weighted (3,000/70) MR images through the shoulder show a ganglion (arrow) in the spinoglenoid notch of the scapula. (c) Oblique coronal sagittal T2-weighted fat-suppressed fast spin-echo MR image (3,000/70) shows edema in the infraspinatus muscle (arrow) secondary to impingement of the suprascapular nerve by the ganglion in the spinoglenoid notch.