Magnetic resonance imaging of the elbow

Abstract

Elbow pain is frequently encountered in clinical practice and can result in significant morbidity, particularly in athletes. Magnetic resonance imaging (MRI) is an excellent diagnostic imaging tool for the evaluation of soft tissue and osteochondral pathology around the elbow. Recent advances in magnetic field strength and coil design have lead to improved spatial resolution and superior soft tissue contrast, making it ideal for visualization of complex joint anatomy. This article describes the normal imaging appearances of anatomy around the elbow and reviews commonly occurring ligamentous, myotendinous, neural, and bursal pathology around the elbow.

Correlation of Preoperative MRI and MRA With Arthroscopically Proven Articular Cartilage Lesions of the Elbow

“…18 The more recent use of gradient-echo sequences, in combination with short tau inversion recovery sequence (for fat suppression) may be better in evaluating articular cartilage and to better delineate loose bodies in the elbow joint; it may also be that 3T MRI will improve the accuracy of the diagnosis of articular cartilage defect compared with the 1.5 T MRI technology used in this study, although this has yet to be demonstrated. 7,[19][20][21] In our series of 31 patients, in comparison with MRI, the use of MRA did not increase the diagnostic accuracy of detecting chondral lesions of any of the 4 anatomical lesions. This is in contrast to the known effects of MRA in enhancing visualization of capsular abnormalities, undersurface collateral ligament tears, OCD, and intraarticular loose bodies.…”

“…4,5 However, MRI does have some limitations in diagnosing elbow pathology, related to positioning difficulty, scarcity of dedicated elbow coils, and lower signal-to-noise ratio at the magnet. 6,7 The literature contains reports using MRI and MRA to detect articular surface lesions in the knee and the shoulder. [8][9][10][11] However, there are no studies assessing the sensitivity, specificity, and accuracy of MRI in detecting isolated chondral lesions of the elbow.…”

Osteochondral Lesions of the Elbow

“…1 and 2), subchondral sclerosis, separated and/or displaced bony fragments, in addition to effusion in the acute setting. 19,20 The radiographic stages of OCD are the radiolucent stage, separation stage, and free (advanced) stage (►Table 2). 21 Negative radiographs do not exclude an osteochondral lesion, and Kijowski and colleagues reported a 66% sensitivity of radiographs in the detection of capitellar OCD and only a 57% detection rate of intra-articular bodies when compared with arthroscopic findings.…”

“…Prior to discussing actual osteochondral injuries of the elbow, normal locations in the elbow that lack cartilage and are observable on MRI should be mentioned: the pseudodefects of the trochlea and the capitellum. 11,19,20,[28][29][30] Because only anterior 180 degrees of the capitellum is covered by articular coverage, the posterior bare area contributes to the pseudodefect of the capitellum (►Fig. 5a).…”

“…11,19,20,[28][29][30] MR imaging has become the imaging standard for the assessment of osteochondral fragment size, location, stability, and viability. 11,15,19,20,26,[31][32][33] In the MRI classification system of OCD described by Nelson et al, there are four grades of lesions: (1) grade 1, intact cartilage with signal change; (2) grade 2, high-signal breach of overlying cartilage; (3) grade 3, thin high-signal rim of fluid extending about the osteochondral fragment; and (4) grade 4, mixed-or low-signal intraarticular body, either in the center of the lesion or free in the joint (►Table 3). 31,34 Early OCD demonstrates focal low-signal intensity in the anterior capitellum on T1-weighted MR images, with or without high T2-weighted signal, and flattening of the subchondral bone plate.…”