MRI Shoulder Without Contrast — Dictation, Appropriateness, and Dose for Residents

Outpatient MSK list. You’ve got a non-contrast shoulder MRI for a 55-year-old with chronic pain and a positive drop-arm test. Your attending expects a full rundown: rotator cuff tear grading, acromial morphology, biceps tendon position, and any hint of labral pathology, even without contrast. Being systematic is key, but being fast and right is the game. When I was a fellow, the hardest part wasn’t seeing the tear; it was making sure my report covered every single base the orthopedic surgeon was looking for, every time. It’s about building a bulletproof report that anticipates their next question. For more tools to help you through training, check out the residents and fellows resource hub we’ve put together.

What an MRI Shoulder Without Contrast Covers and What Attendings Look For

An MRI of the shoulder without contrast is the workhorse for evaluating most causes of shoulder pain, particularly rotator cuff pathology. While an MR arthrogram is superior for detailed labral assessment, the non-contrast study provides a comprehensive overview of the most common pathologies. Your attending is looking for a systematic evaluation that answers the core clinical questions.

A solid report on a non-contrast shoulder MRI should definitively address:

• Rotator Cuff: Is there tendinosis, a partial-thickness tear (articular or bursal-sided), or a full-thickness tear? Note the size, retraction, and any muscle atrophy.
• Biceps Tendon: Is the long head of the biceps tendon located correctly in the bicipital groove? Is there tenosynovitis, subluxation, dislocation, or a tear?
• Acromioclavicular (AC) Joint and Acromion: Is there AC joint arthropathy? What is the acromial morphology (Type 1, 2, or 3)? Are there subacromial spurs causing impingement?
• Glenohumeral Joint and Labrum: While limited without contrast, comment on any gross labral tearing, paralabral cysts, or signs of adhesive capsulitis (frozen shoulder).
• Bones and Marrow: Look for occult fractures, avascular necrosis (osteonecrosis) of the humeral head, or other marrow signal abnormalities.
• Muscles: Evaluate for fatty atrophy, particularly of the supraspinatus and infraspinatus, which can indicate chronic cuff tears or suprascapular nerve compression.
• Bursae: Is there subacromial-subdeltoid bursitis?

Radiology Report Template for MRI Shoulder Without Contrast

This template provides a solid starting point. Remember to tailor it to your institution’s style and the specific findings of the case. The key is a logical, structure-by-structure flow.

Technique

Multiplanar, multisequence MRI of the [right/left] shoulder was performed without intravenous contrast on a [1.5T/3T] magnet. Sequences include coronal oblique T1, coronal oblique PD/T2 fat-saturated, sagittal oblique PD/T2 fat-saturated, and axial PD fat-saturated images.

Findings

ROTATOR CUFF:
Supraspinatus: [Normal signal and morphology. / Mild tendinosis. / Partial-thickness articular-sided tear measuring X mm. / Full-thickness tear measuring X cm with Y cm of tendon retraction. No significant fatty atrophy.]
Infraspinatus: [Normal. / Tendinosis. / Tear. Note any fatty atrophy, which may suggest suprascapular nerve pathology.]
Teres Minor: [Normal.]
Subscapularis: [Normal. / Tendinosis. / Tear.]

BICEPS TENDON:
Long Head of Biceps: [Normal in location within the bicipital groove. / Medially subluxated/dislocated. / Tenosynovitis is present. / Intact. / Partial or complete tear.]

GLENOHUMERAL JOINT AND LABRUM:
Glenoid Labrum: [Grossly intact anteriorly and posteriorly. Evaluation is limited without intra-articular contrast. / Suspected tear at the [location]. / Paralabral cyst noted.]
Articular Cartilage: [Preserved. / Mild chondral thinning.]
Joint Fluid: [No significant effusion.]
Capsule: [Normal axillary recess. / Thickening and enhancement suggestive of adhesive capsulitis.]

ACROMIOCLAVICULAR (AC) JOINT AND SUBACROMIAL SPACE:
AC Joint: [Normal. / Mild/moderate/severe degenerative changes with osteophyte formation.]
Acromion: [Type [1-flat/2-curved/3-hooked] acromion. No significant subacromial spurring.]
Subacromial-Subdeltoid Bursa: [No significant bursal fluid.]

BONES AND MARROW:
Humeral Head: [Normal marrow signal. No evidence of avascular necrosis or occult fracture.]
Glenoid: [Normal.]
Other: [No acute fracture or dislocation.]

MUSCLES:
Rotator Cuff Musculature: [Normal bulk and signal. / Mild/moderate/severe fatty atrophy of the [muscle].]
Deltoid: [Normal.]

OTHER:
Suprascapular Notch: [Unremarkable. No definite ganglion cyst.]

Impression

1. [e.g., Full-thickness tear of the supraspinatus tendon with mild retraction.]
2. [e.g., Moderate AC joint arthropathy with a type 2 acromion, contributing to subacromial impingement.]
3. [e.g., Mild subacromial-subdeltoid bursitis.]

Where to Find More Free Radiology Report Templates

Building a personal library of templates is a rite of passage in residency. If you’re looking for more examples or templates for other modalities, two great free repositories exist. The Radiological Society of North America (RSNA) curates a comprehensive library at RadReport.org, which is an excellent, peer-reviewed resource. Another solid option is Radiology Templates, an Australian-maintained site with a wide variety of templates.

From Free-Form Dictation to a Flawless Structured Report

The challenge with templates is that every case is different. You see a finding, dictate it, then have to slot it into the right place in your template, which can break your concentration. An alternative workflow is to dictate your positive findings in free form as you see them and let software handle the structuring. Tools like GigHz Precision AI are designed for this. You can simply dictate, “full thickness supraspinatus tear with 1.5 cm retraction and moderate fatty atrophy,” and the AI will generate a clean, structured report using pre-loaded ACR and SIR-compliant templates. It helps streamline the reporting process, ensuring all key elements are included without manual copy-pasting, letting you focus on the images.

When Should You Order an MRI Shoulder Without Contrast? ACR Appropriateness Criteria

The American College of Radiology (ACR) provides evidence-based guidelines on imaging appropriateness. For shoulder pain, the choice of study depends heavily on the clinical scenario.

For an adult with acute shoulder pain of any etiology, initial imaging with radiographs is typically the first step. If radiographs are negative or indeterminate and there’s suspicion of an occult fracture, an MRI without contrast is rated “Usually Appropriate.” Similarly, for suspected rotator cuff tears or labral tears on physical exam after inconclusive radiographs, MRI without contrast is “Usually Appropriate.” However, for definitive evaluation of a labral tear or instability, an MR arthrogram is often the preferred next step.

In cases of chronic shoulder pain, MRI without contrast is “Usually Appropriate” for evaluating suspected rotator cuff disorders, subacromial bursitis, biceps tendon abnormalities, or adhesive capsulitis, especially when initial radiographs are normal. For suspected labral pathology or instability in the chronic setting, MR arthrogram is again considered the more sensitive test, though a non-contrast study is still a reasonable and appropriate choice.

Alternative imaging options include:

• MR Arthrography: The gold standard for evaluating the labrum and instability.
• CT Arthrography: An alternative for labral evaluation when MRI is contraindicated.
• Ultrasound: Highly operator-dependent but can be excellent for evaluating the rotator cuff in experienced hands.
• X-ray: The best initial test for evaluating bony abnormalities, fractures, and joint alignment.

MRI Shoulder Without Contrast Imaging Protocol — Sequences, Planes, and Parameters

A high-quality shoulder MRI depends on correct patient positioning and, most critically, proper slice orientation. The coronal and sagittal oblique planes must be angled along the long axis of the supraspinatus tendon on the axial localizer, not along the body’s true coronal or sagittal planes. This single step is crucial for accurately visualizing the rotator cuff.

The following table outlines a standard non-contrast shoulder protocol. Field of view (FOV) is typically 16-18 cm, covering from the AC joint superiorly to the inferior glenoid.

Common protocol pitfalls and variations:

• 3T Imaging: On a 3T scanner, thinner slices can be acquired for higher spatial resolution.
• 3D Isotropic Sequences: Many modern protocols use a single 3D isotropic acquisition (e.g., CUBE, VISTA, SPACE) that can be reformatted into any plane, potentially replacing some of the 2D sequences.
• ABER View: The Abducted and Externally Rotated (ABER) position is rarely used in non-arthrographic studies but can be helpful to stress the anterior-inferior labrum if instability is the primary question.

The 3-Months-Free Residents Offer

3+ months free for radiology residents and fellows

We’re offering an extended free trial of GigHz Precision AI specifically for trainees. The goal is to help you look like a rockstar on your reports. You can dictate your positive findings in free form, and the AI generates a clean, structured report using ACR and SIR templates, with the appropriate clinical decision support firing automatically. All we ask in return is your feedback so we can keep improving the product for residents and fellows on the front lines.

To sign up, we just need three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
3. Your training program / hospital name

Signup is simple. No credit card, no long forms. Just reply to the application with those three items, and we’ll get you set up. You can apply for the residents free-access program here.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Frequently Asked Questions

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. No Protected Health Information (PHI) is required to use the tool for generating structured reports from your findings.

Do I need my hospital’s IT department to set this up?

No. It’s a browser-based tool that requires no local installation. It works on any modern computer, including the call-room PC or your personal iPad, without needing IT approval or integration.

How does this work with PowerScribe or other dictation systems?

It works alongside your existing dictation system. You can dictate your findings into the GigHz tool, which generates the structured report. You then copy and paste the final, clean report into your PACS/RIS, making it a final check before signing.

Can I use this on my phone or iPad?

Yes, the platform is web-based and responsive, so it works on desktops, laptops, tablets, and phones.

Can I customize the templates to match my institution’s preferences?

Yes, custom templates can be created and saved to your account, allowing you to match the specific formatting and subheadings your attendings prefer.

What happens after my residency or fellowship ends?

The free access is for trainees. After you graduate, you can transition to a standard plan. We offer discounts for recent graduates to help you get started in your practice.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026