| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Technical Innovation |
1 Both authors: Department of Diagnostic Radiology, Royal North Shore Hospital, St. Leonards, NSW 2060, Australia.
Received August 8, 2003;
accepted after revision October 6, 2003.
Address correspondence to B. M. Giuffrè
(brunog{at}med.usyd.edu.au).
Introduction
 Top Introduction Materials and MethodsResultsDiscussionReferences |
|---|
|
TopIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
|
We initially performed a three-plane localizer, with either three or five images in the axial, sagittal, and coronal planes. The coronal localizer images (sagittal elbow anatomy) were used to plan the sequences along the long axis of the distal biceps brachii tendon (along the line of the tendon if it is visible). If the tendon was not clearly seen on the localizer images, the series was planned nearly perpendicular to the radius, which was always clearly seen (Fig. 2). The normal flexed abducted supinated view showed the full length of the tendon (Fig. 3). Images in axial, and in some cases sagittal, planes were then also obtained with the shoulder in abduction and the elbow extended in the overhead position. It is also possible to obtain the axial and sagittal images with the arm by the side. Series with and without fat suppression were performed (proton density fast spin echo; TR/TE, 3,000/34 or 45) along the axis of the tendon (elbow flexed) and axial to the elbow joint (elbow extended). The field of view was 15 x 15 cm, and the slice thickness was 3 or 4 mm with interslice spacing of zero. For the flexed abducted supinated view, usually 18 slices were obtained with an approximate examination time of 2 min 40 sec.
|
|
|
TopIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
Three cases among 22 elbows in the study group exhibited normal distal biceps brachii tendons; in 14 cases, evidence of a partial tear or tendinosis of the distal biceps brachii tendon (Figs. 4 and 5) was present; in four cases, a complete tear (Fig. 6) was present; and in one case, an intact repaired complete tear was seen. In all cases, the full length of the biceps brachii tendon from musculotendinous junction to insertion on the radial tuberosity could be shown in one or, at most, two sections. In the 13 cases in which sagittal series were also performed, a single section less commonly (n = 8) showed the full tendon in one or two sections.
|
|
|
In four of these six asymptomatic volunteer evaluations, the flexed abducted supinated view showed the complete length of the tendon in one section; in the other two cases, it was seen in two sections. In the sagittal series of the healthy volunteers, the full tendon was seen in one section in only two cases.
|
TopIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
Complete rupture is often an avulsion from the radial attachment and is often clinically evident. The differentiation of complete tears from partial tears is sometimes confusing clinically, particularly if the lacertus fibrosis remains intact. The treatment of complete tears without retraction or partial tears can benefit from precise delineation of the extent of the abnormality [3, 7]. MRI of distal biceps brachii tendon tears has been described in several articles [3, 7, 8].
MRI of the distal biceps brachii tendon is often difficult because of the anatomic course of the tendon close to its insertion. Studies have described several different methods of patient positioning for optimally imaging the elbow using MRI [3–8]. The patient is usually most comfortable supine with the arms by the sides. The off-axis position of the arm makes fat suppression poor with resultant variable signal homogeneity. Problems also occur with obese or large-framed patients in whom difficulty fitting the coil and patient into the confined space of the magnet bore is experienced. One alternative described involves positioning the patient supine or prone with the arm outstretched above the head, elbow extended, and forearm supinated [4]. The signal strength and homogeneity are superior in this overhead position.
Sagittal images through the distal biceps brachii tendon may be difficult to interpret because of partial volume-averaging effects due to the oblique course of the tendon to its insertion.
Flexion of the elbow is associated with contraction of the biceps muscle belly, and the tendon is taut. With the forearm supinated, the radial tuberosity is directed medially and with the elbow flexed, the distal tendon is in an almost direct line from the muscle belly to its insertion. The flexed abducted supinated view successfully achieves a longitudinal view of the distal biceps brachii tendon often in one section, including the difficult-to-assess insertion on the radial tuberosity. Because the tendon is assessed longitudinally and is at full length, the differentiation of partial from complete tears is made easier. The position of the elbow near the center of the magnet makes fat suppression optimal, enhancing visualization of small amounts of fluid.
The traditional axial image of the distal biceps brachii tendon is also a valuable means of assessing this structure. Aside from providing a short-axis image of the tendon, the axial series provides a familiar view of the important associated structures such as the median and radial nerves at the elbow.
In conclusion, the flexed abducted supinated view provides a reproducible technique for MRI of the distal biceps brachii tendon, obtaining a longitudinal image of the tendon from the musculotendinous junction to its insertion, often in one section.
Acknowledgments
We thank David Connell for his inspiration for this positioning and Sandy
Huggett, radiographic technologist, Royal North Shore Hospital and Tim
McLellan, radiographic technologist, North Shore Radiology, for their
assistance with this work.
|
TopIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  H. T. Sanal, L. Chen, P. Negrao, P. Haghighi, D. J. Trudell, and D. L. Resnick Distal Attachment of the Brachialis Muscle: Anatomic and MRI Study in Cadavers Am. J. Roentgenol., February 1, 2009; 192(2): 468 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Dirim, S. S. Brouha, M. L. Pretterklieber, K. S. Wolff, A. Frank, M. N. Pathria, and C. B. Chung Terminal Bifurcation of the Biceps Brachii Muscle and Tendon: Anatomic Considerations and Clinical Implications Am. J. Roentgenol., December 1, 2008; 191(6): W248 - W255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Teh Imaging of the elbow Imaging, September 1, 2007; 19(3): 220 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Chew and B. M. Giuffre Disorders of the Distal Biceps Brachii Tendon RadioGraphics, September 1, 2005; 25(5): 1227 - 1237. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
