What is the recommended structured reporting format for a Magnetic Resonance Imaging (MRI) of the shoulder for a radiologist?

Structured Reporting Format for MRI Shoulder

The recommended structured reporting format for MRI shoulder should include standardized sections for indication, technique, findings organized by anatomical structures, and impression/conclusion, with specific attention to rotator cuff integrity, labral pathology, and joint stability.

Indication

• Clearly state the reason for the examination, including relevant clinical history, symptoms, and suspected pathology 1
• Document any history of trauma, prior surgeries, or previous imaging studies for comparison 1
• Include relevant patient risk factors and current clinical status 1

Technique

• Field strength of MRI scanner (minimum 1.5T recommended) 1
• Sequences performed (T1-weighted, T2-weighted, STIR, etc.) 1
• Imaging planes acquired (axial, coronal, sagittal) 2
• Use of contrast agent (if applicable), including name, dose, and administration method 1
• Note any technical limitations or artifacts that may affect interpretation 1
• Document overall study quality and any factors limiting assessment 1

Findings

Organize findings by anatomical structures in a logical sequence:

Osseous Structures

• Humeral head: contour, alignment, marrow signal 3
• Glenoid: morphology, version, cartilage integrity 3
• Acromion: morphology (flat, curved, hooked), presence of spurs 1
• Acromioclavicular joint: alignment, arthrosis 3
• Coracoid process: morphology, relationship to humeral head 4

Rotator Cuff

• Supraspinatus tendon: integrity, signal characteristics, tears (partial vs. complete) 1, 4
• Infraspinatus tendon: integrity, signal characteristics 3
• Subscapularis tendon: integrity, signal characteristics 4
• Teres minor: integrity, signal characteristics 4
• Rotator cuff muscles: size, fatty infiltration, atrophy 1

Biceps Tendon

• Long head of biceps: position, integrity, tenosynovitis 1
• Biceps anchor/labral attachment 4

Labrum and Capsule

• Superior labrum: morphology, SLAP lesions 5
• Anterior labrum: integrity, Bankart lesions 5
• Posterior labrum: integrity 5
• Inferior labrum: integrity 5
• Glenohumeral ligaments: integrity, variants 6
• Joint capsule: thickening, scarring, laxity 4

Joint Space

• Glenohumeral joint: effusion, loose bodies 4
• Subacromial/subdeltoid bursa: fluid, thickening 1
• Acromioclavicular joint: effusion, arthrosis 3

Impression/Conclusion

• Provide a clear answer to the clinical question that prompted the examination 1
• Summarize key findings with emphasis on clinically relevant abnormalities 1
• Compare with prior imaging studies when available 1
• Categorize findings based on clinical significance (normal, benign, suspicious) 1
• Provide specific recommendations for follow-up or additional imaging if needed 1

Important Considerations

• Use standardized terminology for describing rotator cuff tears (partial vs. full thickness, size, retraction) 1
• Document the 17-segment model when applicable for describing focal abnormalities 1
• Include measurements for significant findings (e.g., tear size, acromiohumeral distance) 1
• Note normal variants to avoid misinterpretation as pathology 6
• Correlate imaging findings with clinical presentation when information is available 7

Common Pitfalls to Avoid

• Misinterpreting normal variants (especially at the anterosuperior labrum) as pathology 6
• Overlooking subtle partial-thickness rotator cuff tears 5
• Failing to evaluate the entire rotator cuff, including the rotator cable 3
• Not commenting on muscle quality (atrophy, fatty infiltration) which impacts surgical planning 1
• Inadequate assessment of the biceps-labral complex 4
• Missing subtle Hill-Sachs or Bankart lesions in patients with instability 1