Magnetic resonance imaging of the supraspinatus tendon: The significance of signal intensity alterations at the‘criticalzone’

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Abstract
A pictorial essay of normal and abnormal appearances of the supraspinatus tendon is presented. An increased signal intensity within the supraspinatus tendon on short TE sequences is not necessarily abnormal. Increased signal seen within the tendon on modern magnetic resonance imaging (MRI) units is often due to a phenomenon known as the 'magic angle' effect. Only when supraspinatus tendon signal intensity is greater than that of muscle on long TE (T2) sequences should it be considered to be abnormal. The physical basis for the magic angle effect is outlined and a pictorial essay demonstrating the practical implications of this effect is presented. A comparison is made to signal intensity changes seen with partial and complete tears of the supraspinatus tendon. Correlation is made with important morphologic features of partial or complete tears.