3D is essential for any joint, believe it or not. 2D just doesn’t cut it for us. Case in point- you have papers showing 90% accuracy for labral tears- if you do 3D of hip- rarely, there is no labral tear.
With compressed sense- 3D is 3 minutes acquisition isotropic for knee and 4 min and few sec for hip.
On our older 1.5T scanners- we do VIBE / THRIVE for MRA of shoulder
On newer 1.5T or 3T scanners- 3D PD
Advantages- can find every labral tear, tiny paralabral cysts- otherwise not visible, measure labral tears, measure bone loss, ligaments are much sharper and darker (rest of extraneous tissue which causes full thickness tear to mimic high-grade or near- full-thickness of ligament on 2D due to partial voluming is clearly delineated), you can re-orient the planes along axis of cuff in coronals/labrum in sagittal, etc- to visualize subtle tears and much better anatomy (one of well-trained fellow was overcalling free-edge truncation of meniscus body on 2D today- on 3D, sharp meniscus could be seen all the way around ).
I can share myriad of cases but Alas!- swamped with lots of volumes and not able to send cases these days.
I do not know from where so many patients are coming to our setup!
To summarize- for MR arthrogram- we do fsT1W, T2 Dixon, 3D PD, ABER T1fs obl axial
Another opinion- we do not need any MR arthrograms with 3D imaging. E.g. we asked our hip preservation surgeon to not send any MRAs in future as labral tears on surgery are sub-1mm and every labral tear is seen on 3D- he can see them all as well. Also, we can generate radials for his liking.
Best!
AC
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>
www.utsouthwestern.edu<www.utsouthwestern.edu/>
________________________________
From: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com> on behalf of Jan Fritz <janfritz777@gmail.com>
Sent: Tuesday, April 5, 2022 8:03 PM
To: rjklecker@gmail.com <rjklecker@gmail.com>
Cc: OCAD-msk GOOGLE GROUPS <ocad-msk@googlegroups.com>
Subject: Re: MR arthrogram: what sequences do you use?
EXTERNAL MAIL
There has been a small wave of papers reporting on using high-res isotropic fat-suppressed VIBE/LAVA/THRIVE/TIGRE for MR arthrograms as a 2D T1FS TSE substitute.
My experience: The isotropic nature of the datasets is great for inter-active dynamic MPR assessment at the work state (SSR meeting shout-out to Andy Sonin!), but the gradient echo nature too often resulted in “gray” rather than “black” glenoid labrum and tendons, and also reduced signal intensity of the Gadolinium-enhanced injectant. In essence, the contrast-to-noise ratios between fibrocartilage and tendons on one side and Gadolinium on the other were often too narrow to diagnose small tears with sufficient certainty. So we went back to 2D T1 TSE with < TR 800 ms, minimal TE, and < ETL of 4 without or with FS.
Jan
On Tue, Apr 5, 2022 at 5:51 PM RJ Klecker <rjklecker@gmail.com<mailto:rjklecker@gmail.com>> wrote:
Hello!
Today we had a patient who kept his appointment for shoulder arthrogram despite the ongoing tornado sirens and stormy weather here. The arthrogram was easy, no complaints.
Then the resident and I got a call from MR that the pt did not think he could sit in the scanner for the rest of the study. We spoke to the patient, showed hip that the scanner was open at both ends, etc, and then proceeded to shorten the scan time as much as possible on the fly.
This is a Philips Aspire 3T and I asked the techs if we could run a VIBE- (which is the Thrive on the Philips). Here is what we got. Is anyone using this routinely? I am not thrilled with the coronal images but the exam is diagnostic. Also ran the T2wfs coronal, sag PDfs, and axial PD.
What sequences are you running for your MR arthrograms (assuming you are still doing them)?
Thank you-
Rosemary
