Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view.

he distal biceps brachii tendon is an uncommon site for tendon injury, representing 3% of all injuries of the biceps brachii tendon in the literature [1, 2]. There have been many suggestions for optimally imaging the elbow using MRI [3–8]. Axial imaging is often used, providing short-axis images of the tendon, to accurately show the anatomy and disease of the distal biceps tendon. In many circumstances, a long-axis image of the tendon is also useful. On direct sagittal images with the elbow extended, the distal biceps brachii tendon usually suffers from partial volume-average effects because of its oblique course to its insertion. We describe a novel way of positioning the patient with the shoulder abducted, elbow flexed, and forearm supinated. This allows us to obtain images of the distal biceps brachii tendon from the musculotendinous junction to its insertion , usually on a single image. Materials and Methods Imaging was performed on a 1.5-T MRI scanner (Signa Horizon LX, release 9.0, General Electric Medical Systems) with either the extremity coil or the dedicated shoulder phased array coil. In general, it was preferable for the patient to lie prone for these views. The shoulder was abducted 180°, with the arm beside the head. The elbow was flexed to 90°, with the forearm supinated, thumb up, and a shoulder phased array coil was placed around the elbow (Fig. 1). The position is referred to in this article as the flexed abducted supinated view, but usually in our practice it is termed the " FABS view, " meaning the flexed elbow with the shoulder abducted and the forearm in supination view. We initially performed a three-plane localizer, with either three or five images in the axial, sagittal, and coronal planes. The coronal localizer images (sagittal elbow anatomy) were used to plan the sequences along the long axis of the distal biceps brachii tendon (along the line of the tendon if it is visible). If the tendon was not clearly seen on the localizer images, the series was planned nearly perpendicular to the radius, which was always clearly seen (Fig. 2). The normal flexed abducted supinated view showed the full length of the tendon (Fig. 3). Images in axial, and in some cases sagittal, planes were then also obtained with the shoulder in abduction and the elbow extended in the overhead position. It is also possible to obtain the ax-ial and sagittal images with …