Comparative study of direct MR arthrography and CT arthrography with arthroscopic correlation in preoperative evaluation of anterior shoulder instability

Purpose

To compare direct MR arthrography and CT arthrography for the preoperative planning of shoulder anterior instability.

Patients and methods

47 patients were included in this study. 43 patients with clinical history of anterior GHI or recurrent shoulder pain had no clinical findings of rotator cuff abnormality. They experienced multiple anterior dislocations of the shoulder. No patient showed evidence of multidirectional instability or generalized ligamentous laxity. The remaining 4 patients complained of anterior shoulder instability after anchor repair. All the patients underwent direct CT and MR arthrography. The results of CTA and MRA were compared with results obtained from arthroscopy in each patient to detect the sensitivity and specificity of each modality.

Results

The sensitivity and specificity of CTA for bankart lesion are 89.4% and 96.4% respectively and of MRA 94.7% and 96.4%, for Perthes lesion the sensitivity and specificity of CTA are 33.3% and 100% respectively and of MRA 66.6% and 100%, for ALPSA the sensitivity and specificity of CTA are 85.7% and 97.5% respectively and of MRA 100% and 97.5%, for GLAD the sensitivity and specificity of CTA are 80% and 97.6% respectively and of MRA 60% and 97.6%, for SLAP lesion the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 100% and 100%, for absent or degenerated labrum the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 66.6% and 97.7%, for post operative recurrent Bankart lesion the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 50% and 100%, for bony glenoid fracture the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 66.6% and 97.5%.

Conclusion

CTA and MRA were equivalent in demonstrating labro-ligamentous and cartilaginous lesions associated with shoulder instability. CTA was superior in detecting post operative instability and glenoid rim osseous lesions that are known to be a decisional element in the surgical strategy. Hence, CTA may be considered a method of choice in the preoperative evaluation of shoulder anterior instability.     

Sensitivity of MR arthrography in the evaluation of acetabular labral tears

OBJECTIVE: MRI has historically provided suboptimal visualization of tears of the acetabular labrum. Degenerative fraying and underlying cartilage abnormalities can often mimic tears of the labrum on conventional MRI. Administration of intraarticular gadolinium enhances the MRI appearance of the labrum to improve detection of labral abnormalities. This study examined the improved diagnostic sensitivity of MR arthrography compared with conventional MRI and the importance of confining the study to a small field of view. MATERIALS AND METHODS: Fifty-one hips were imaged in 48 patients. Fourteen hips underwent conventional MRI with a large field of view (30-38 cm). Seven hips underwent conventional MRI with a small field of view (14-20 cm). Thirty hips underwent MR arthrography with a small field of view (14-20 cm). Labral tears were diagnosed when contrast material was identified within the labrum or between the labrum and the acetabulum, when a displaced fragment was noted, or when a paralabral cyst was identified. All study results were compared with findings at the time of hip arthroscopy. RESULTS: Conventional MRI with a large field of view was 8% sensitive in detecting labral tears compared with findings at the time of arthroscopy. Diagnostic sensitivity was improved to 25% with a small field of view. MR arthrography with a small field of view was 92% sensitive in detecting labral tears. CONCLUSION: A combination of MR arthrography and a small field of view is more sensitive in detecting labral abnormalities than is conventional MRI with either a large or a small field of view.     

One-shot MR and MDCT arthrography of shoulder lesions with arthroscopic correlation

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of sub-millimeter multiple detector CT (MDCT) technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications.     

The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis

Objectives  

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have been advocated for the diagnosis of acetabular labral tears. The purpose of this study was to determine the sensitivity and specificity of MRI and MRA in diagnosing acetabular labral tears using meta-analysis.     

Meta分析MRI及MR关节成像诊断髋臼盂唇撕裂准确性的研究

目的 MRI及MR关节成像(MRA)被推荐用于诊断髋臼盂唇撕裂。本研究的目的是用Meta分析法确定MRI及MRA诊断髋臼盂唇撕裂的敏感性及特异性。材料与方法     

Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips

Background: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears.

Purpose: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints.

Material and Methods: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints.

Results: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%.

Conclusion: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.     

3.0T常规MRI与MR髋关节造影诊断髋臼唇撕裂的对比研究

目的 在3.0 T场强中,比较常规髋关节MRI及MR髋关节造影对髋臼唇撕裂的诊断价值.方法 回顾分析44例髋关节病变患者的患侧髋关节常规MRI及MR髋关节造影资料,将每例患者的臼唇划分为前、上、后3处区域(共计132处),确定有无撕裂,并进行分型.其中5例患者经髋关节镜检查.对于常规MRI及MR髋关节造影获得的臼唇撕裂及分型数据差异比较采用Wilcoxon秩和检验,一致性比较采用Kappa检验.结果 常规MRI与MR髋关节造影诊断完全相同者计116处臼唇,只有16处存在诊断差异.其中,前者诊断无撕裂而后者诊断撕裂者9处,前者诊断撕裂但后者诊断无撕裂者6处,其余1处两者均诊断为撕裂但分型不同.常规MRI与MR髋关节造影的评价差异没有统计学意义(Z=0.347,P＞0.05),且具有极好的一致性(K=0.781,P＜0.01).在接受关节镜的5例患者中,常规MRI、MR髋关节造影及关节镜结果均完全吻合.结论 对髋臼唇撕裂,3.0 T常规髋关节MRI可获得与MR髋关节造影基本相同的诊断效果.     

髋关节MR造影在髋臼唇撕裂诊断中的应用

目的 探讨髋关节MR造影在髋臼唇撕裂诊断中的应用价值.方法 临床高度怀疑髋臼唇撕裂的15例20个髋关节在透视下行髋关节穿刺造影,采用SE T1WI加脂肪抑制技术,进行髋关节冠状面、矢状面、斜轴面及放射状位扫描.其中12例行关节镜检查.结果 在行髋关节镜检查的12例14个髋关节中,11例13个髋关节MR造影诊断为髋臼唇撕裂,与关节镜诊断相符;1例MR造影示正常,关节镜检查亦未发现髋臼唇撕裂.13个髋臼唇撕裂中位于前上象限12个髋关节,后上象限1个髋关节.在关节镜诊断髋臼唇撕裂的13个髋关节中,MR造影冠状面诊断髋臼唇撕裂3个髋关节,矢状面诊断10个髋关节,斜轴面及放射状位诊断髋臼唇撕裂均为13个髋关节.15例20个髋关节中有5例6个髋关节在后下象限有髋臼唇下沟表现.结论 MR髋关节造影是诊断髋臼唇撕裂的可靠方法,扫描方法应选择T1WI加脂肪抑制的矢状面及斜轴面或矢状面加放射状位.后下象限撕裂的诊断中应注意正常变异的存在.

Abstract：

Objective To investigate the application value of MR rthrography (MRA) in the diagnosis of acetabular labral tears. Methods Fifteen patients with a high degree of suspected acetabular labral tears received fluoroscope-guided injection of the contrast media into the hip joint ( hip arthrography) and fat-saturated spin-echo T1-weighted images were obtained in the coronal, sagittal, oblique-axial and radial planes. Hip arthroscopy was performed on 12 of them. Results Labral tears which were diagnosed in 11 patients by hip MRA were confirmed at hip arthroscopy. One patient showed no MRA indication of labral tear, also showed normal on arthroscopy. Tear in the anterior-superior quadrant 10 cases of 12 joints ( 12/13), posterior-superior quadrant 1 case of a joint (1/13). In 11 patients who underwent arthroscopy, hip MRA diagnosed 3 (3/13) joints labral tears in coronal planes, 10 (10/13) joints in sagittal planes and 13 (13/13) labral tears in axial-oblique and radial planes. In 15 patients with 20 hip joints, 5 cases 6 joints (6/20) with normal acetabular sublabral sulcus were performed. Conclusions MR arthrography of hip is a reliable method in the diagnosis of acetabular labral tears. Scanning method should be included fat-saturated spin-echo T1-weighted images in sagittal and oblique-axial planes or sagittal plus radial planes. The diagnosis of tor posterior-inferior quadrant should pay attention to the existence of a normal variation.     

Prognostic value of chondral defects on the outcome after arthroscopic treatment of acetabular labral tears

Pathology of the acetabular labrum plays an increasing role in the treatment of hip pain. Hip arthroscopy has proven its clinical value as a useful procedure for successful treatment of labral tears. Until today, only a few studies have investigated the influence of articular cartilage defects on the clinical outcome of partial arthroscopic labrum resection in a larger patient population. We prospectively evaluated patients with an intraoperatively proven labral lesion/tear without any radiological and arthroscopical sign of a concomitant bony femoroacetabular impingement or hip dysplasia for a minimum postoperative follow-up of 2 years. Cartilage defects were classified according to Outerbridge and divided into two subgroups: Outerbridge ≤ 1 and Outerbridge ≥ 2, respectively. To evaluate combined results, various established scoring systems (visual analogue scale, modified Harris Hip Score, Larson Hip Score) were used. Out of 54 originally enrolled patients, 50 individuals (29 female, 21 male) with a median age of 33 years (range 15–49) were available for follow-up after a mean of 34 (range 24–48) months. At follow-up, the total study population experienced significant improvement in pain and in the combined evaluation scales (Larson Hip Score/MHHS). When patients were categorized into two subgroups, either with intraoperatively present or absent articular cartilage defects, our data indicated that subjects with no degenerative changes of the articular cartilage surface significantly improved in the applied clinically scoring systems. In contrast, in patients with an articular cartilage lesion during hip arthroscopy score values had a tendency to be unimproved or even deteriorated at follow-up. Regression analysis revealed a significant negative correlation between postoperative outcome and the grading of the coexistent articular cartilage defect. On the basis of our investigation, we conclude that partial arthroscopic resection of a torn labrum without attending bone deformity (dysplasia or femoroacetabular impingement) can reveal good and satisfied results. Depending on the extent of a coexisting articular cartilage defect subjective clinical results are compromised.     

Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation

OBJECTIVE: Conventional radiography, arthrography, CT arthrography, and MR arthrography--including use of the abduction and external rotation position--were compared, with arthroscopic correlation, to determine the spectrum of abnormalities encountered and the relative benefits of each imaging method in the evaluation of shoulder lesions occurring in 17 throwing athletes. SUBJECTS AND METHODS: Each of 36 athletes with shoulder pain aggravated by abduction and external rotation was examined in a single visit during which conventional radiography, arthrography, CT arthrography, and MR arthrography were performed. In 17 of these athletes, imaging findings were compared with those at arthroscopy. All images were independently evaluated by two groups of musculoskeletal radiologists. RESULTS: Structures found to be affected were, in decreasing order of frequency, the following: the posterosuperior labrum, supraspinatus tendon, infraspinatus tendon, humeral head, glenoid cavity and rim, acromioclavicular joint, anteroinferior capsulolabral complex, biceps tendon, and subscapularis tendon. MR arthrography without and with abduction and external rotation yielded the highest sensitivity and specificity for all lesions with the exceptions of bone sclerosis and enthesophytes (which were best seen with CT arthrography). MR arthrography with abduction and external rotation was most accurate for diagnosis of rotator cuff and anteroinferior capsulolabral complex tears. CONCLUSION: On the basis of these preliminary results, we believe that MR arthrography with abduction and external rotation should be part of the imaging evaluation of shoulder pain in throwing athletes, owing to the high sensitivity of this imaging technique.     

Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation

Purpose

The purpose of this study was to determine inter- and intraobserver variability of MR arthrography of the shoulder in the detection and classification of superior labral anterior posterior (SLAP) lesions.

Methods

MR arthrograms of 78 patients who underwent MR arthrography before arthroscopy were retrospectively analysed by three blinded readers for the presence and type of SLAP lesions. MR arthrograms were reviewed twice by each reader with a time interval of 4 months between the two readings. Inter- and intraobserver agreement for detection and classification of SLAP lesions were calculated using κ coefficients.

Results

Arthroscopy confirmed 48 SLAP lesions: type I (n?=?4), type II (n?=?37), type III (n?=?3), type IV (n?=?4). Sensitivity and specificity for detecting SLAP lesions with MR arthrography for each reader were 88.6%/93.3%, 90.9%/80.0% and 86.4%/76.7%. MR arthrographic and arthroscopic grading were concurrent for 72.7%, 68.2% and 70.5% of SLAP lesions for readers 1–3, respectively. Interobserver agreement was excellent (κ?=?0.82) for detection and substantial (κ?=?0.63) for classification of SLAP lesions. For each reader intraobserver agreement was excellent for detection (κ?=?0.93, κ?=?0.97, κ?=?0.97) and classification (κ?=?0.94, κ?=?0.84, κ?=?0.93) of SLAP lesions.

Conclusion

MR arthrography allows reliable and accurate detection of SLAP lesions. In addition, SLAP lesions can be diagnosed and classified with substantial to excellent inter- and intraobserver agreement.     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography

Objective In recent years, radial imaging has been advocated for improved visualization of the acetabular labrum in magnetic resonance arthrography of the hip. The purpose of this study was to investigate whether radial imaging demonstrates labral tears not visible on standard imaging planes. Methods Fifty-four consecutive magnetic resonance (MR) arthrograms of the hip that included radial imaging over 2 years were retrospectively analyzed by two radiologists. Standard imaging planes and radial imaging were reviewed for identification of labral tears in four specific areas of the labrum: anterosuperior, posterosuperior, anteroinferior, and posteroinferior. The standard imaging sequences include fat-saturated spin-echo T1-weighted images in the coronal and oblique axial planes, non-fat-saturated T1-weighted images in the coronal and sagittal planes, and T2-weighted sequence in the axial plane. Radial imaging was performed as previously described using fat-saturated T1-weighted sequences. Results Using standard imaging planes, 50 anterosuperior, 31 posterosuperior, 10 anteroinferior, and 9 posteroinferior labral tears were detected in 54 MR arthrograms of the hip. Using radial sequences alone, 44 anterosuperior, 25 posterosuperior, 9 anteroinferior, and 5 posteroinferior labral tears were detected. In all four areas of the labrum, the radial imaging did not show any labral tear not seen on standard imaging planes. Discussion In MR arthrography of the hip, radial imaging did not reveal any additional labral tears. Standard imaging planes sufficiently demonstrate all acetabular labral tears.     

肩关节上唇前后性损伤:外旋和有效后旋位CT关节成像与中立位CT关节成像的比较

目的比较外旋和有效后旋(ERAS)位CT关节成像及中立位CT关节成像对肩关节上唇前后(SLAP)性损伤的诊断能力。材料与方法已获得机构审查委员会的批准和知情同意书。对47例病人的49个肩关节行中立位和ERAS位CT关节成像,随后关节镜证实了上唇的情况。2名肌骨系     

The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings

Purpose

The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery

Material and methods

This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings.

Main outcome measures

Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum.

Results

Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results.The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients.

Conclusion

MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy.     

Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography

Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.