J Korean Soc Radiol.  2020 Jan;81(1):21-40. 10.3348/jksr.2020.81.1.21.

Optimization of MRI Protocol for the Musculoskeletal System

• Lee HS
• Lee YH
• Jung I
• Song OK
• Kim S
• Song HT
• Suh JS

• KMID: 2469180
• DOI: http://doi.org/10.3348/jksr.2020.81.1.21

Abstract

Magnetic resonance imaging (MRI) is an essential modality for the diagnosis of musculoskeletal system defects because of its higher soft-tissue contrast and spatial resolution. With the recent development of MRI-related technology, faster imaging and various image plane reconstructions are possible, enabling better assessment of three-dimensional musculoskeletal anatomy and lesions. Furthermore, the image quality, diagnostic accuracy, and acquisition time depend on the MRI protocol used. Moreover, the protocol affects the efficiency of the MRI scanner. Therefore, it is important for a radiologist to optimize the MRI protocol. In this review, we will provide guidance on patient positioning; selection of the radiofrequency coil, pulse sequences, and imaging planes; and control of MRI parameters to help optimize the MRI protocol for the six major joints of the musculoskeletal system.

MeSH Terms

Diagnosis
Joints
Magnetic Resonance Imaging*
Musculoskeletal Diseases
Musculoskeletal System*
Patient Positioning

Figure

• 

  Fig. 1. Dedicated shoulder RF coil. The shoulder is slightly externally rotated, and the shoulder cup of the RF coil is attached to the shoulder using the height adjustment bar. Since the shoulder joint is an off-center joint, it should be positioned at the center of the bore and the RF coil should be closely attached to the shoulder joint. RF = radiofrequency

• 

  Fig. 2. Imaging plane of shoulder MRI. A-D. In shoulder MRI, based on axial images (A and C), the oblique coronal images (B) are obtained at right angles to the glenoid fossa (A), and the oblique sagittal images (D) are obtained perpendicular to the oblique coronal plane or parallel to the glenoid fossa (C). On the oblique coronal image (B), the glenoid labrum (asterisks) and the long course of the supraspinatus tendon and its attachment (arrow) to the greater tuberosity are well visualized. On the oblique sagittal image (D), the muscles forming the rotator cuff (asterisks) are visible. Clockwise from the 12 o’ clock position, the supraspinatus muscle, infraspinatus muscle, teres minor muscle, and subscapularis muscle are depicted.

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  Fig. 3. Elbow flexible RF coil. The coil is a flexible RF coil that can be used for small joints. The patient is in close contact with the elbow joint. Depending on the physique of the patient, small and medium sizes are available. RF = radiofrequency

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  Fig. 4. Dedicated wrist RF coil. By using the RF coil dedicated to the wrist joint, the patient can main-tain the joint in a neutral position while laying supine, thereby enabling stable image acquisition. The superman position may be considered to place the wrist joint at the center of the magnetic field. However, if the acquisition time is long, the patient may feel uncomfortable. RF = radiofrequency

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  Fig. 5. Torso RF coil for hip joint imaging. The coil is a multi-channel torso RF coil that can cover a wide field of view required for hip joint MRI, enabling imaging of both the hips and pelvic bones. RF = radiofrequency

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  Fig. 6. Dedicated knee RF coil. A type of dedicated RF coil for the knee joint, which can be separated up and down. When the knee joint is placed inside the coil, it is slightly flexed. Recently, radiologists have begun using the transmit-receiver coil, in which case the connectors are located on both sides. RF = radiofrequency

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  Fig. 7. Dedicated ankle RF coil. The ankle joint RF coil is designed so that the lower leg and the foot are al-most at right angles to each other, enabling correct posture for imaging. If a flexible coil is used, a positioner may be used to enhance patient comfort. RF = radiofrequency

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