MRI of the shoulder with its excellent soft tissue discrimination, and high spatial resolution offers the best noninvasive way to study the shoulder. MRI images of the bone, muscles and tendons of the glenohumeral joint can be obtained in any oblique planes and projections. MRI gives excellent depiction of rotator cuff tears, injuries to the biceps tendon and damage to the glenoid labrum. Shoulder MRI is better than ultrasound imaging at depicting structural changes such as osteophytic spurs, ligament thickening, and acromial shape that may have predisposed to tendon degeneration.
A dedicated shoulder coil and careful patient positioning in external rotation with the shoulder as close as reasonably possible to the center of the magnet is necessary for a good image quality. If possible, the opposite shoulder should be lifted up, so that the patient lies on the imaged shoulder in order to rotate and fix this shoulder to reduce motion during breathing.
Axial, coronal oblique, and sagittal oblique proton density with fat suppression, T2 and T1 provide an assessment of the rotator cuff, biceps, deltoid, acromio-clavicular joint, the glenohumeral joint and surrounding large structures. If a labral injury is suspected, a Fat Sat gradient echo sequence is recommended. In some cases, a direct MR shoulder arthrogram with intra-articular injection of dilute gadolinium or an indirect arthrogram with imaging 20 min. after intravenous injection may be helpful.

See also Imaging of the Extremities.

Knee and shoulder MRI exams are the most commonly requested musculoskeletal MRI scans. Other MR imaging of the extremities includes hips, ankles, elbows, and wrists. Orthopedic imaging requires very high spatial resolution for reliable small structure definition and therefore places extremely high demands on SNR.
Exact presentation of joint pathology expects robust and reliable fat suppression, often under difficult conditions like off-center FOV, imaging at the edge of the field homogeneity or in regions with complex magnetic susceptibility.
MR examinations can evaluate meniscal dislocations, muscle fiber tears, tendon disruptions, tendinitis, and diagnose bone tumors and soft tissue masses. MR can also demonstrate acute fractures that are radiographically impossible to see. Evaluation of articular cartilage for traumatic injury or assessment of degenerative disease represents an imaging challenge, which can be overcome by high field MRI applications. Currently, fat-suppressed 3D spoiled gradient echo sequences and density weighted fast spin echo sequences are the gold-standard techniques used to assess articular cartilage.
Open MRI procedures allow the kinematic imaging of joints, which provides added value to any musculoskeletal MRI practice. This technique demonstrates the actual functional impingements or positional subluxations of joints. In knee MRI examinations, the kinematical patellar study can show patellofemoral joint abnormalities.

See also Open MRI, Knee MRI, Low Field MRI.

Manufactured by Esaote S.p.A.;
a low field open MRI scanner with permanent magnet for orthopedic use. The outstanding feature of this MRI system is a patient friendly design with 24 cm diameter, which allows the imaging of extremities and small body parts like shoulder MRI. The power consumption is around 1.3 kW and the needed minimum floor space is an area of 16 sq m.
At RSNA 2006 Hologic Inc. introduced a new dedicated extremity MRI scanner, the Opera. Manufactured by Esaote is the Opera a redesign of Esaote's 0.2 Tesla E-Scan XQ platform, which now enables complete imaging of all extremities, including hip and shoulder applications. 'Real-time positioning' reportedly speeds patient setup and reduces exam times.
Esaote North America and Hologic Inc are the U.S. distributors of this MRI device.

From Hitachi Medical Systems America, Inc.;
the AIRIS made its debut in 1995. Hitachi followed up with the AIRIS II system, which has proven equally successfully. 'All told, Hitachi has installed more than 1,000 MRI systems in the U.S., holding more than 17 percent of the total U.S. MRI installed base, and more than half of the installed base of open MR systems,' says Antonio Garcia, Frost and Sullivan industry research analyst. Now Altaire employs a blend of innovative Hitachi features called VOSI™ technology, optimizing each sub-system's performance in concert with the other sub-systems, to give the seamless mix of high-field performance and the patient comfort, especially for claustrophobic patients, of open MR systems.

From Toshiba America Medical Systems Inc.;
the EXCELART is a superconducting whole body MRI system with a short wide-bore magnet, operating at 1.5 T. It features powerful high-speed gradients with a revolutionary gradient acoustic noise reduction system: Pianissimo. The dramatic reduction of gradient acoustic noise by Pianissimo greatly enhances patient comfort during exams. The standard array platform and a wide range of array coils ensure excellent images. A powerful 64-bit RISC-based computer system and newly developed array processor realize high productivity.