肩关节常见疾病MRI诊断-Ⅰ
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峰下撞击综合征
SLAP病变（上盂唇前后向撕裂） Bankart病变 HAGL病变（盂肱下韧带肱骨部撕脱） Labrum cyst 盂唇囊肿 Adhesive capsulitis joints粘连性关节囊炎 Shoulder joint osteoarthrosis肩关节骨关节病
Etiology pathology 病因病理：
On all pulse sequence, signals are increased在所有
脉冲序列上，信号均增高
Tendon thickening, signal not usually homogeneous肌腱常常增厚、信号不均匀 Partial tear, visible water signal in the tendons, but only partial tendon involvement
MRI斜冠状位示冈上肌腱增粗，连续性好，T1W和T2W信号均增高(箭)
4A
4B
Fig 4: Bursal-sided partial thickness tear of the subscapularis.冈上肌腱上表面 部分撕裂.4A:Oblique coronal T2-weighted image shows partial disrupture of the bursal-sided tendon fibers (arrow). The articular-sided fibers are intact.
肌腱下表面部分撕裂。常规MRI 斜冠状位FS T2W示冈上肌腱止点处下表面撕裂( 箭) ，信号增 高，但上表面完整
4C
4D
Fig4C: Intratendinous partial thickness tear of the subscapularis. 冈上肌腱腱内部分 撕裂。Oblique coronal T2-weighted MR image shows abnormal intratendinous fluid accumulation (arrows). The bursal-sided and articular-sided fi bers are intact常规MRI 斜冠状位FS T2W示冈上肌腱止点处腱内限局液性高信号影( 箭) ，肌腱上下表面均完 整.Fig4D: Articular-sided partial thickness tear of the subscapularis.冈上肌腱下表面 部分撕裂。 Oblique coronal T1-weighted MR arthrographic image shows partial discontinuity of the articular-sided fi bers (arrows), with contrast material leaking into the substance of the tendon, and intact bursal-sided fi bers. MRI造影
常规MRI 斜冠状位FS T2W 示冈上肌腱止点处上表面部分撕裂，局部见液性高信号(箭)，伴肩 峰下滑囊积液，下表面完整.4B:partial thickness tear of the subscapularis.
Oblique coronal T2-weighted MR image shows partial discontinuity of the articular-sided tendon fi bers (arrow).The bursal-sided fi bers are intact.冈上
Fig 3 Tendinitis.肩袖变性。 Coronal oblique MR images of the shoulder
show the supraspinatus tendon is diffuse thickening, with intrasubstance intermediate signal on T1-weighted and T2-weighted MR images(arrow).常规
生于胶原血管病患者
Can be acute, but more often repeated attacks on the basis of the already suffer from tendon disease可急性发生，
但更常在已患有肌腱病的基础上反复发作
Tendon thickening, hardening; Partial or total disruption; Some tear on slippery bursa, articular surface or in the stroma肌腱增厚、硬化；部分或完全中断；部分撕裂可
(PartⅠ)
Wang chaoyan 2013/05/27
Shoulder disorders mainly involve rotator cuff diseases and shoulder instability. For rotator cuff diseases, routine shoulder MR imaging as the first choice can solve most of the problems in practice. For shoulder instability and related glenoid labrum lesions, shoulder MR arthrography is the first selection for evaluation
斜冠状位示高信号对比剂进入冈上肌腱下表面(箭)，但未进入肩峰下滑囊
5A
5B
Fig 5:Different MRI techniques for labral tear.盂唇撕裂对比。 Fig5A :
An axial routine MR image shows intact anteroinferior labrum. 常规MRI 轴位示 盂唇未见撕裂征象； Fig5B: An axial MR arthrographic image demonstrates tear of the anteroinferior labrum (arrow).MRI造影轴位示前方盂唇撕裂(箭)
角箭头）。
Fig 1 Subdeltoid–subacromial bursitis.肩峰下滑囊炎。Coronal oblique MR images of the shoulder show fluid in the dilated subdeltoid–subacromial bursa (arrow head).常规MRI斜 冠状位示肩峰下滑囊积液(箭头)； 1A: SE T1W; 1B: TSE T2W. Fig 2 Acromial morphology.肩 峰形态。A. Shape of the Acromion. Type I, flatⅠ型，肩 峰下表面为一平面；Type II, curvedⅡ型，肩峰下表面为弧形 凹面；Type III, hooked Ⅲ型， 肩峰下表面前部呈钩状突； B. Sagittal oblique image shows a Type II acromion and a degenerative spur at the anteroinferior edge of the acromion (arrow). MRI造影斜矢 状位示肩峰前下缘的骨刺(箭)， Ⅱ型肩峰
在滑囊面、关节面或间质中
Collagen degeneration, but there is no inflammatory cells, chronic tendon can appear in fatty infiltration
胶原变性，但没有炎性细胞，慢性肌腱撕裂中可出现脂肪浸润
Ⅰ period: rotator cuff, especially hills tendon edema and hemorrhage肩袖特别是岗上肌腱水肿和出血Tendonitis or inflammatory lesions, it is better to send in less than 25 years old young man. reversible 肌腱炎
部分撕裂，在肌腱中可见水样信号，但只是部分肌腱受累
Tendon full-thickness tear, liquid into tendon fractures, with varying degrees of tendon retraction肌腱全层撕裂，液体进入肌腱裂隙中，伴不同程度的肌腱回缩 Tendon full-thickness tear of the chronic patients to merge muscle fat atrophy肌腱全层撕裂的慢性患
者可合并肌肉脂性萎缩
Thin contrast sketch below outline of the rotator cuff (white arrow)薄的造影剂勾画
出肩袖的下面轮廓（白长 箭头），
Normal joint capsule (black arrow),正常关
节囊（黑箭头），
axillary fossae (white triangle arrows).腋隐窝 （白三
☆Best location: being is 1 cm, from the hills muscle to the greater
tuberosity attachment points (no vascular distribution).
最好发部位：岗上肌距大结节附着点1cm处（无血管分布）。
PDWI
T2WI
Fra Baidu bibliotek
MR arthrogram
PDWI（质子加权像）：supraspinatus tendonobviously obviously irregular (long arrow); 岗上肌肌腱明显不规则（长箭头所示）；T2WI：found similar signal, in line with the tear of the parts (long arrow);发现相似信号符合部分撕裂（长箭头所示） ；MR arthrogram（关节造 影）：contrast agent into the shoulder sleeve material, but not falling down to the shoulder peak capsule (arrow), in addition, a small part of contrast agents, inserted near the shoulder sleeve (long arrow).造影剂进入肩袖实质内，但未沿伸到肩峰下滑囊（三角箭头所
或炎性病变，最好发于小于25岁的青年人,可逆.
Ⅱ period: inflammation further progress and more fibrous tissue formation 炎症进一步进展及更多的纤维组织形 成Happens at 25～45 years old. 好发于25-45岁。 Ⅲ period: rotator cuff tear.肩袖撕裂。 Often occur in more than 45 years old. 常发于45岁以上。
肩关节常见病变主要为肩袖相关病变和肩关节不稳定。对于 肩袖相关病变，肩关节MRI 常规扫描可作为首选；对于肩关 节不稳定和盂唇病变，则一般首选肩关节MRI 造影进行评价。
Rotator cuff tendons disease肩袖肌腱病 Rotator cuff tear肩袖撕裂 Subscapularis rupture肩胛下肌断裂 Acromioclavicular joint disease肩锁关节病 The sub-acromial shoulder impingement syndrome肩
Excessive use, lead to degeneration and tear of rotator cuff 过度使用导致肩袖的退行性变和撕裂 Most often in impingement 最常继发于撞击综合征 Can occur in patients with collagen vascular disease可发
SLAP病变（上盂唇前后向撕裂） Bankart病变 HAGL病变（盂肱下韧带肱骨部撕脱） Labrum cyst 盂唇囊肿 Adhesive capsulitis joints粘连性关节囊炎 Shoulder joint osteoarthrosis肩关节骨关节病
Etiology pathology 病因病理：
On all pulse sequence, signals are increased在所有
脉冲序列上，信号均增高
Tendon thickening, signal not usually homogeneous肌腱常常增厚、信号不均匀 Partial tear, visible water signal in the tendons, but only partial tendon involvement
MRI斜冠状位示冈上肌腱增粗，连续性好，T1W和T2W信号均增高(箭)
4A
4B
Fig 4: Bursal-sided partial thickness tear of the subscapularis.冈上肌腱上表面 部分撕裂.4A:Oblique coronal T2-weighted image shows partial disrupture of the bursal-sided tendon fibers (arrow). The articular-sided fibers are intact.
肌腱下表面部分撕裂。常规MRI 斜冠状位FS T2W示冈上肌腱止点处下表面撕裂( 箭) ，信号增 高，但上表面完整
4C
4D
Fig4C: Intratendinous partial thickness tear of the subscapularis. 冈上肌腱腱内部分 撕裂。Oblique coronal T2-weighted MR image shows abnormal intratendinous fluid accumulation (arrows). The bursal-sided and articular-sided fi bers are intact常规MRI 斜冠状位FS T2W示冈上肌腱止点处腱内限局液性高信号影( 箭) ，肌腱上下表面均完 整.Fig4D: Articular-sided partial thickness tear of the subscapularis.冈上肌腱下表面 部分撕裂。 Oblique coronal T1-weighted MR arthrographic image shows partial discontinuity of the articular-sided fi bers (arrows), with contrast material leaking into the substance of the tendon, and intact bursal-sided fi bers. MRI造影
常规MRI 斜冠状位FS T2W 示冈上肌腱止点处上表面部分撕裂，局部见液性高信号(箭)，伴肩 峰下滑囊积液，下表面完整.4B:partial thickness tear of the subscapularis.
Oblique coronal T2-weighted MR image shows partial discontinuity of the articular-sided tendon fi bers (arrow).The bursal-sided fi bers are intact.冈上
Fig 3 Tendinitis.肩袖变性。 Coronal oblique MR images of the shoulder
show the supraspinatus tendon is diffuse thickening, with intrasubstance intermediate signal on T1-weighted and T2-weighted MR images(arrow).常规
生于胶原血管病患者
Can be acute, but more often repeated attacks on the basis of the already suffer from tendon disease可急性发生，
但更常在已患有肌腱病的基础上反复发作
Tendon thickening, hardening; Partial or total disruption; Some tear on slippery bursa, articular surface or in the stroma肌腱增厚、硬化；部分或完全中断；部分撕裂可
(PartⅠ)
Wang chaoyan 2013/05/27
Shoulder disorders mainly involve rotator cuff diseases and shoulder instability. For rotator cuff diseases, routine shoulder MR imaging as the first choice can solve most of the problems in practice. For shoulder instability and related glenoid labrum lesions, shoulder MR arthrography is the first selection for evaluation
斜冠状位示高信号对比剂进入冈上肌腱下表面(箭)，但未进入肩峰下滑囊
5A
5B
Fig 5:Different MRI techniques for labral tear.盂唇撕裂对比。 Fig5A :
An axial routine MR image shows intact anteroinferior labrum. 常规MRI 轴位示 盂唇未见撕裂征象； Fig5B: An axial MR arthrographic image demonstrates tear of the anteroinferior labrum (arrow).MRI造影轴位示前方盂唇撕裂(箭)
角箭头）。
Fig 1 Subdeltoid–subacromial bursitis.肩峰下滑囊炎。Coronal oblique MR images of the shoulder show fluid in the dilated subdeltoid–subacromial bursa (arrow head).常规MRI斜 冠状位示肩峰下滑囊积液(箭头)； 1A: SE T1W; 1B: TSE T2W. Fig 2 Acromial morphology.肩 峰形态。A. Shape of the Acromion. Type I, flatⅠ型，肩 峰下表面为一平面；Type II, curvedⅡ型，肩峰下表面为弧形 凹面；Type III, hooked Ⅲ型， 肩峰下表面前部呈钩状突； B. Sagittal oblique image shows a Type II acromion and a degenerative spur at the anteroinferior edge of the acromion (arrow). MRI造影斜矢 状位示肩峰前下缘的骨刺(箭)， Ⅱ型肩峰
在滑囊面、关节面或间质中
Collagen degeneration, but there is no inflammatory cells, chronic tendon can appear in fatty infiltration
胶原变性，但没有炎性细胞，慢性肌腱撕裂中可出现脂肪浸润
Ⅰ period: rotator cuff, especially hills tendon edema and hemorrhage肩袖特别是岗上肌腱水肿和出血Tendonitis or inflammatory lesions, it is better to send in less than 25 years old young man. reversible 肌腱炎
部分撕裂，在肌腱中可见水样信号，但只是部分肌腱受累
Tendon full-thickness tear, liquid into tendon fractures, with varying degrees of tendon retraction肌腱全层撕裂，液体进入肌腱裂隙中，伴不同程度的肌腱回缩 Tendon full-thickness tear of the chronic patients to merge muscle fat atrophy肌腱全层撕裂的慢性患
者可合并肌肉脂性萎缩
Thin contrast sketch below outline of the rotator cuff (white arrow)薄的造影剂勾画
出肩袖的下面轮廓（白长 箭头），
Normal joint capsule (black arrow),正常关
节囊（黑箭头），
axillary fossae (white triangle arrows).腋隐窝 （白三
☆Best location: being is 1 cm, from the hills muscle to the greater
tuberosity attachment points (no vascular distribution).
最好发部位：岗上肌距大结节附着点1cm处（无血管分布）。
PDWI
T2WI
Fra Baidu bibliotek
MR arthrogram
PDWI（质子加权像）：supraspinatus tendonobviously obviously irregular (long arrow); 岗上肌肌腱明显不规则（长箭头所示）；T2WI：found similar signal, in line with the tear of the parts (long arrow);发现相似信号符合部分撕裂（长箭头所示） ；MR arthrogram（关节造 影）：contrast agent into the shoulder sleeve material, but not falling down to the shoulder peak capsule (arrow), in addition, a small part of contrast agents, inserted near the shoulder sleeve (long arrow).造影剂进入肩袖实质内，但未沿伸到肩峰下滑囊（三角箭头所
或炎性病变，最好发于小于25岁的青年人,可逆.
Ⅱ period: inflammation further progress and more fibrous tissue formation 炎症进一步进展及更多的纤维组织形 成Happens at 25～45 years old. 好发于25-45岁。 Ⅲ period: rotator cuff tear.肩袖撕裂。 Often occur in more than 45 years old. 常发于45岁以上。
肩关节常见病变主要为肩袖相关病变和肩关节不稳定。对于 肩袖相关病变，肩关节MRI 常规扫描可作为首选；对于肩关 节不稳定和盂唇病变，则一般首选肩关节MRI 造影进行评价。
Rotator cuff tendons disease肩袖肌腱病 Rotator cuff tear肩袖撕裂 Subscapularis rupture肩胛下肌断裂 Acromioclavicular joint disease肩锁关节病 The sub-acromial shoulder impingement syndrome肩
Excessive use, lead to degeneration and tear of rotator cuff 过度使用导致肩袖的退行性变和撕裂 Most often in impingement 最常继发于撞击综合征 Can occur in patients with collagen vascular disease可发