From the Guidelines
For most shoulder injuries, an MRI without contrast is the recommended initial imaging approach. This is based on the American College of Radiology's (ACR) appropriateness criteria for shoulder pain-traumatic, which suggests that noncontrast MRI is effective in diagnosing most traumatic soft-tissue pathologies, including labral, rotator cuff, and glenohumeral ligament injuries 1. The use of contrast-enhanced MRI may be considered in specific situations, such as evaluating for infection, inflammatory arthritis, or tumors, but this is not typically the first-line approach.
Some key points to consider when deciding between an MRI with or without contrast for a shoulder injury include:
- The specific clinical situation and suspected diagnosis
- The presence of any underlying medical conditions, such as kidney disease, that may affect the use of contrast agents
- The potential benefits and risks of contrast administration, including the risk of allergic reaction
- The effectiveness of noncontrast MRI in diagnosing common shoulder injuries, such as rotator cuff tears and labral tears 1
In general, noncontrast MRI is a safe and effective initial imaging approach for most shoulder injuries, and can provide valuable information for diagnosis and treatment planning. However, the decision to use contrast or not should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, as recommended by the ACR appropriateness criteria 1.
From the Research
Shoulder Injury MRI Protocol
When it comes to diagnosing shoulder injuries using MRI, the decision to use contrast or not depends on the specific condition being evaluated.
- For rotator cuff tears, both MRI and ultrasound are accurate, but each has its advantages and shortcomings 2.
- Adhesive capsulitis of the shoulder can be accurately diagnosed on non-contrast MRI examinations with appropriate clinical criteria without direct MR arthrography 3.
- For the assessment of soft tissue and articular disorders of the shoulder, MRI and ultrasound have comparable accuracy for detection of full-thickness rotator cuff tears, while MRA and US might be more accurate for the detection of partial-thickness tears than MRI 4.
- A comparison of MRI and ultrasound for shoulder imaging suggests that both are viable options, with advantages and disadvantages for each modality 5.
- A prospective, double-blind comparison of MRI and arthroscopy found that MRI was highly accurate in detecting full-thickness supraspinatus tears and acromioclavicular joint pathology, but had poor concordance with arthroscopy in diagnosing pathology in the biceps tendon 6.
Contrast Use in Shoulder MRI
The use of contrast in shoulder MRI may be beneficial in certain cases, such as:
- Evaluating the extent and location of labrum tears, where MRA has an advantage over CTA 4.
- Detecting occult bone injuries in the elbow, where plain MRI or MRA have an advantage over CTA 4.
- Improving the concordance between MRI and arthroscopy in diagnosing shoulder pathology, possibly through the use of intraarticular contrast 6.