Classification of supraspinatus muscle atrophy in MRI according to Zanetti [142

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Magnetic resonance imaging was performed on a 1.0-Tesla scanner. A sequence of parasagittal T1-weighted turbo spin-echo MRI images (repetition time [TR]/echo time [TE]: 700/12 ms) parallel to the glenohu-meral joint space was obtained.

For quantitative assessment, areas and SIs of the rotator cuff muscle and the area of the fossa supraspinata were measured at the most lateral image on which the scapular spine is in contact with the rest of the scapula (Fig. 14 a).

Tangent Sign: Qualitative assessment of atrophy of the supraspinatus muscle: For quick qualitative evaluation of atrophy of the supraspinatus muscle a morphologic sign was introduced. A line (tangent) was drawn through the superior borders of the scapular spine and the superior margin of the coracoid (Fig. 14 d). The tangent sign was defined as abnormal (positive) (Fig. 14e,f) when the supraspinatus muscle did not cross the tangent. The tangent sign is a qualitative sign of muscle atrophy with a high predictive value. Obviously, its use is limited to the su-praspinatus muscle, which is not adequate for all types of tears.

Table 2. Occupation ratio of the supraspinatus fossa related to grade of supraspinatus tendinopathy

Normal or slightly atrophied Moderate atrophy Serious or severe atrophy

Normal or slightly atrophied Moderate atrophy Serious or severe atrophy

Scapular Mri

Fig. 14A-F. A The most lateral image on which the scapulars spine is in contact with the rest of the scapula was chosen as reference section. B Areas and mean signal intensities were obtained using regions of interest determined by the contours of the supraspinatus (?), infraspinatus (2); teres minor (3), and subscapularis muscle (4). C Measurement of the area of the supraspinatus (?) and the mean signal intensity of the teres major muscle (2). D Because the border between the infraspinatus and teres minor muscles cannot reproducibly be measured, these two measurements were combined for the purpose of the investigation. This figure demonstrates all measurements used in this investigation for quantification of the rotator cuff: supraspinatus muscle (?); supraspinatus fossa (2); combined measurement of the infraspinatus and teres minor muscles (3); and subscapularis muscle (4). Note normal (negative) tangent sign: the normal supraspinatus muscle reaches above the line drawn through the superior borders of the coracoid and scapular spine

Fig. 14A-F. A The most lateral image on which the scapulars spine is in contact with the rest of the scapula was chosen as reference section. B Areas and mean signal intensities were obtained using regions of interest determined by the contours of the supraspinatus (?), infraspinatus (2); teres minor (3), and subscapularis muscle (4). C Measurement of the area of the supraspinatus (?) and the mean signal intensity of the teres major muscle (2). D Because the border between the infraspinatus and teres minor muscles cannot reproducibly be measured, these two measurements were combined for the purpose of the investigation. This figure demonstrates all measurements used in this investigation for quantification of the rotator cuff: supraspinatus muscle (?); supraspinatus fossa (2); combined measurement of the infraspinatus and teres minor muscles (3); and subscapularis muscle (4). Note normal (negative) tangent sign: the normal supraspinatus muscle reaches above the line drawn through the superior borders of the coracoid and scapular spine

Infraspinatus Muscle Pictures
Fig. 14. E A borderline abnormal (positive) tangent sign. F Positive tangent sign

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