Clinical impact of including the shoulder joint in coronal-short TI inversion recovery sequence in a routine cervical spine MRI.

Introduction: Clinical and pathological conditions of the cervical spine and shoulder often overlap due to anatomical proximity and shared neural pathways, hindering accurate identification of the pain source in patients with concurrent neck and shoulder symptoms. This study evaluated whether including the shoulder joints in coronal Short TI Inversion Recovery (STIR) sequences during cervical spine MRI improves diagnostic outcomes.

Methods: This prospective observational study included 116 patients with non-traumatic neck and/or shoulder symptoms. Cervical spine MRI was performed using a phased-array spine coil with routine sagittal and axial T1-and T2-weighted sequences, supplemented by a coronal STIR sequence with expanded field of view (FOV; 360-400 mm), angulated inferolaterally to include both shoulders. STIR parameters included repetition time: 2900 ms, echo time: 41 ms, inversion time: 140 ms, echo train length: 12, bandwidth: 19.23 Hz, slice thickness: 3 mm, slice gap: 3 mm, frequency: 128, phase: 192, excitation number: 3, and scan time: 2.2 min.

Results: Shoulder abnormalities were detected in 32 patients (27.6 %) with fluid in the rotator cuff region (n = 22), subcoracoid bursae (n = 4), glenohumeral joint (n = 2), and acromioclavicular joint (n = 3). One patient had fluid adjacent to the shoulder, associated with tubercular lymphadenitis.

Conclusion: Including shoulder joints in the coronal STIR sequence during cervical spine MRI can help identify pain sources more accurately, helping in accurate diagnosis and effective patient management.

Implications For Practice: Incorporating shoulder joints in the coronal STIR sequence of cervical spine MRI enhances diagnostic efficiency for overlapping neck and shoulder symptoms. This may enable physicians to manage cases more effectively, save time, and potentially reduce the need for further imaging investigations in some cases.