How much weighting does T1 Weighting deserve? – Tips and tricks for reading T1 sequences in Musculoskeletal MR scans
Educational Exhibit at the European Congress of Radiology, Vienna, 2019
(Note: images here are for representation only. Please write to us in case you would like the actual images)
To learn the importance of T1 weighted sequences in the interpretation of MSK MR scans.
Fluid sensitive sequences like FSPD and STIR are given more importance by many readers while interpreting musculoskeletal MRI. T1 weighted sequences are usually ignored.
Findings and procedure details
Broad concepts On T1W:
- Loss of Fat around ligaments – sign of injury
- Loss of Fat around nerves – sign of impingement /invasion
- Effaced fat in the normal recess- sign of synovial thickening- – ankle (lateral ankle recess), acetabulum (acetabular fat pad), knee – posterior margin of the Hoffa fat
- Differentiation between edema and subchondral cyst
- Patchy subchondral FSPD hyperintensity without T1W hypointensity is due to post-traumatic increased microvascularity.
- Fat – fluid level inside bone in osteomyelitis implies intramedullary fat necrosis
- lipo- hemarthrosis – sign of intra-articular cortical fracture.
- Chronic injuries appear hypointense – De Quervain’s, chronic MCL scarring.
- Bright on STIR/FSPD and Dark on T1W- Abnormal.
- Sagittal T1 – fatty infiltration, Contour of the muscles
- Better delineation of glenoid fossa sclerosis.
- Sagittal T1W- for nerve root
- Pars breaks
flavumvs facet joint arthropathy
- Calcification of Disc fragment and PLL – Markedly hypointense
- Cord – myelomalacia vs.
- Marrow infiltrative disorder vs hematopoietic disorder – Marrow T1 signal dark than muscles implies infiltrative disorder
Hip: Sub articular bright signal of
Elbow: axial T1 intermediate signal – lateral epicondylitis