Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. MATERIALS AND METHODS: Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. RESULTS: Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. CONCLUSION: MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.     

上方盂唇前后向撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对上方盂唇前后向撕裂(SLAP损伤)的诊断价值.方法 由2名影像诊断医师独立回顾分析137例经肩关节镜证实的肩关节造影MR图像,判定有无SLAP损伤,并进行分型.SLAP损伤分4型:Ⅰ型为上盂唇毛糙,Ⅱ型为肱二头肌腱盂唇复合体从关节孟撕裂,Ⅲ型为上盂唇桶柄状撕裂,Ⅳ型为上盂唇桶柄状撕裂并同时累及肱二头肌长头腱.计算肩关节MR造影对SLAP损伤的敏感度、特异度和准确度,以及与肩关节镜分型的符合率.采用Kappa统计计算2名影像诊断医师评价的一致性.结果 137例患者中,肩关节镜证实SLAP损伤59例,包括SLAP损伤Ⅰ型6例(10.2%)、Ⅱ型50例(84.7%)、Ⅲ型3例(5.1%).肩关节MR造影的敏感度、特异度和准确度医师甲分别为86.4%(51/59)、78.2%(61/78)和81.8%(112/137),医师乙分别为88.1%(52/59)、84.6%(66/78)和86.1%(118/137).2名影像诊断医师的评价一致性极好(K=0.796).肩关节MR造影与肩关节镜的分型符合率医师甲为83.1%(49/59),医师乙为79.7%(47/59).结论 肩关节MR造影是评价SLAP损伤比较可靠的影像方法.     

MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls

OBJECTIVE: Using MR arthrography, we examined normal anatomy, anatomic variations, and pitfalls of imaging the labral capsular ligamentous complex in the asymptomatic shoulder. SUBJECTS AND METHODS: We obtained 108 MR arthrograms of the glenohumeral joint in 95 asymptomatic volunteers with axial (108 shoulders) and oblique coronal (56 shoulders) images. We examined labral shape, patterns of capsular insertion, presence or absence of glenohumeral ligaments, and pitfalls of imaging. Our patients were men (auxiliary policemen) between 19 and 24 years old (mean age, 21 years). RESULTS: The shapes of labra were triangular (anterior part, 64%; posterior part, 47%), round (17%; 33%), flat (2%; 17%), cleaved (11%; 1%), notched (3%; 0%), or absent (2%; 2%). Using the system of Mosely and Overgaard, the anterior capsular insertion was type 1 in 63% of shoulders, type 2 in 20%, and type 3 in 17%; the posterior capsular insertion was type 1 in 60% of shoulders, type 2 in 31%, and type 3 in 9%. The superior and inferior glenohumeral ligaments were present in 99% of shoulders, but the middle glenohumeral ligament was present in only 79%. We also detected many pitfalls of MR imaging in identifying findings such as the undercutting of the labrum by cartilage (32% of shoulders), prominent axillary folds (46%), sublabral holes (7%) or recesses (33%), Buford complexes (2%), and sulci between the biceps tendon and superior labrum (30%). CONCLUSION: Knowledge of normal anatomy and anatomic variations of the labral complex is important for the examination of the shoulder with MR arthrography.     

Diagnosis of SLAP lesions with Grashey-view arthrography

OBJECTIVE: To examine the accuracy of Grashey views obtained during shoulder arthrography in the diagnosis of clinically relevant superior labrum anterior-posterior (SLAP) lesions. DESIGN AND PATIENTS: Grashey views obtained during diagnostic arthrography (conventional and MR) were used to examine the superior labrum. Twenty-eight of 118 shoulder arthrograms obtained during a 27-month period fulfilled study criteria and were correlated for accuracy using arthroscopically confirmed grade 2-4 SLAP lesions as the standard of reference. Arthrograms were graded using the consensus method. Prevalence, sensitivity, specificity, and accuracy were 21%, 50%, 86%, and 79%. The appearance of the superior labrum on the Grashey view was compared subjectively with MR arthrography. Sources of errors were analyzed. CONCLUSION: Grashey views obtained during shoulder arthrography can diagnose clinically relevant SLAP lesions with moderately high specificity, moderate accuracy, and limited sensitivity. Findings on the Grashey view closely resemble those seen on coronal oblique MR arthrography. Grashey views should be considered in patients undergoing shoulder arthrography.     

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder

PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder. MATERIALS AND METHODS: From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography. RESULTS: SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography. CONCLUSION: MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon.     

MR arthrography of the adult acetabular capsular-labral complex: correlation with surgery and anatomy.

OBJECTIVE: Our purpose was to describe the appearance of the acetabular capsular-labral complex on MR arthrography and to correlate this appearance with surgical findings in adult patients and with gross anatomic findings in cadavers. SUBJECTS AND METHODS: MR arthrography of the hip joint was performed in 40 patients and six cadavers. All patients underwent subsequent arthrotomy of the hip. MR arthrography consisted of a T1-weighted three-dimensional gradient-echo sequence in both the coronal oblique and sagittal oblique planes after intraarticular injection of a 2 mmol/l solution of gadopentetate dimeglumine. The normal and pathologic appearance of the capsular-labral complex was assessed, and the labra were evaluated on the basis of morphology, signal intensity, presence of a tear, and attachment to the acetabulum. MR arthrography findings were correlated with the surgical results in all patients and with the anatomic sections of the cadaveric hip joint specimens. RESULTS: MR arthrography images of the T-weighted three-dimensional gradient-echo sequences allowed visualization of the anatomic structures. The normal labrum was triangular, without any sublabral sulcus, and of homogeneous low signal intensity. A recess between the labrum and the joint capsule could be identified in instances in which no thickened labrum was present. Labral lesions included labral degeneration, a tear, or a detached labrum either with or without thickening of the labrum. The sensitivity for detection and correct staging of labral lesions with MR arthrography in the patient study was 91%; the specificity, 71%; and the accuracy, 88%. CONCLUSION: MR arthrography with T1-weighted three-dimensional gradient-echo sequences allows excellent assessment of the normal and pathologic acetabular capsular-labral complex.     

3D-SPACE序列在肩关节MR造影中评估上盂唇前后撕裂

目的：评价肩关节 MR造影三维各向同性脂肪抑制快速自旋回波（SPACE）序列对上盂唇前后撕裂（SLAP损伤）的诊断价值。方法：影像诊断医师回顾性分析经关节镜证实的肩关节 MR 造影图像,判定有无SLAP 损伤及分型,对比常规二维序列和SPACE序列对SLAP损伤的敏感度、特异度及准确率,比较常规二维序列与SPACE 序列的诊断价值。结果：肩关节镜证实SLAP损伤12例,肩关节 MR造影SPACE序列与常规二维序列对SLAP 损伤的敏感度分别为83．33％（10/12）及91．67％（11/12）,特异度分别为81．25％（13/16）及87．50％（14/16）,准确度分别为82．14％（23/28）及89．29％（25/28）。SPACE序列与常规二维序列对 SLAP 损伤的诊断效能无明显统计学差异（P＞0．05）。结论：肩关节MR造影中SPACE序列是评价SLAP损伤准确、可靠的影像学方法。     

Superior labral anteroposterior lesions: MR arthrography with arm traction.

OBJECTIVE: The purpose of this study was to investigate the efficacy of arm traction combined with MR arthrography in the evaluation of superior labral anteroposterior (SLAP) lesions. MATERIALS AND METHODS: Cadaveric shoulders were studied with a 1.5-T MR imaging unit with the arm externally rotated. Fifteen milliliters of a gadolinium-containing contrast agent were injected into the glenohumeral joint. Twenty-four sets of images of cadaveric joints were evaluated independently by two observers. These sets consisted of MR arthrographic images obtained with traction (applied to the wrist using 1- to 3-kg weights) and without traction in five shoulders in which SLAP lesions had been excluded arthroscopically or by cadaveric sectioning; and MR arthrographic images obtained with and without traction in seven shoulders in which various types of SLAP lesions had been created arthroscopically and later confirmed by cadaveric sectioning. RESULTS: Analysis of the data indicated that MR arthrography in combination with arm traction and external rotation improved diagnostic accuracy with regard to identification and categorization of SLAP lesions when compared with studies made without traction. CONCLUSION: The combination of MR arthrography and arm traction with the shoulder in external rotation provides a more effective approach for detection of SLAP lesions than does similar MR arthrography performed without arm traction.     

SLAP lesions: anatomy, clinical presentation, MR imaging diagnosis and characterization

Superior labral anterior posterior (SLAP) tears are an abnormality of the superior labrum usually centered on the attachment of the long head of the biceps tendon. Tears are commonly caused by repetitive overhead motion or fall on an outstretched arm. SLAP lesions can lead to shoulder pain and instability. Clinical diagnosis is difficult thus imaging plays a key diagnostic role. The normal anatomic variability of the capsulolabral complex can make SLAP lesions a diagnostic challenge. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes or marrow edema in the humeral head, capsular laxity, Hill-Sachs or Bankart lesion. The relevant anatomy, capsulolabral anatomic variants, primary and secondary findings of SLAP tears including MR arthrography findings, types of SLAP lesions and a practical approach to labral lesions are reviewed.     

Capsulo-labro-ligamentous lesions of the shoulder: evaluation with MR arthrography

PURPOSE: The aim of the study was to analyse the accuracy of MR arthrography in the evaluation of capsulo-labro-ligamentous lesions of the shoulder in patients with glenohumeral joint instability. MATERIALS AND METHODS: From 1999 to 2001 fifty-eight patients with glenohumeral joint instability were studied by MR arthrography. Twenty-seven patients underwent surgical repair: 11 by arthroscopic and 16 by arthrotomic approach. All shoulder evaluations were performed with T1 and T2 weighted axial, coronal and sagittal oblique images, before and after intra-articular injection of gadolinium contrast. RESULTS: Forty capsulo-ligamentous lesions (including 14 capsular ruptures with extravasation of the contrast medium) were detected by MR arthrography. Fifty-two labral tears (36 of the anterior, 13 of the superior and 3 of the posterior glenoid labrum) were identified: 11 out of 52 were not recognized before gadolinium contrast injection. Five rotator cuff tears were identified, one of which was not shown in the pre-injection examination. Surgical results confirmed the MR arthrographic findings in 25/27 patients. In one case MR arthrography did not recognize a SLAP lesion; in another case it identified a tear of the capsule but not of the glenoid labrum. CONCLUSIONS: In many cases of subacute glenohumeral joint lesions with intracapsular fluid, MR may accurately evaluate capsulo-labral-ligamentous lesions. Indeed, the examination of lesions is limited by the absence of the natural contrast determined by fluid; in such cases, intra-articular injection of gadolinium contrast is necessary. MR arthrography evaluates the degree of capsulo-labro-ligamentous tears and may guide the surgical approach.     

Shoulder MR arthrography: which patient group benefits most?

OBJECTIVE: We sought to compare the diagnostic accuracy of conventional MRI versus MR arthrography of the shoulder in the assessment of high-performance athletes (professional baseball players) and to compare our findings in these patients with the conventional MRI and MR arthrographic findings in an age-matched control group of nonprofessional athletes. MATERIALS AND METHODS: Conventional MRI and MR arthrographic examinations of the shoulder in 20 consecutive professional baseball players with shoulder pain were reviewed retrospectively by two musculoskeletal radiologists in consensus. These interpretations were compared with retrospective consensus interpretations of conventional MRI and MR arthrographic examinations of the shoulder obtained in a control group of 50 consecutive nonprofessional athletes with shoulder pain. MR images were assessed for full- or partial-thickness supraspinatus tendon tears, superior labral anteroposterior (SLAP) tears, and anterior or posterior labral tears. RESULTS: In the 20 consecutive professional athlete patients, two full-thickness and six partial-thickness undersurface supraspinatus tendon tears were seen on MR arthrography but not seen on conventional MRI as well as six SLAP tears, two anterior labral tears, and one posterior labral tear. Three patients had both SLAP tears and full- or partial-thickness supraspinatus tendon tears. Of 14 patients with findings on MR arthrography that were not seen on MRI, 11 had arthroscopic correlation. In all 11, arthroscopic findings confirmed findings on MR arthrography. In the group of 50 nonprofessional athlete patients, five had additional findings on MR arthrography not seen on conventional MRI: two anterior labral tears, two partial-thickness supraspinatus tendon tears, and two SLAP tears. One patient had both a partial-thickness supraspinatus tendon tear and a SLAP tear seen on MR arthrography. The five patients with additional findings on MR arthrography had arthroscopy. In all five, arthroscopic findings confirmed the findings on MR arthrography. CONCLUSION: MR arthrography is considerably more sensitive for detection of partial-thickness supraspinatus tears and labral tears than conventional MRI. MR arthrography showed injuries in addition to those seen on conventional MRI in 14 of 20 patients in the high-performance athlete group. These results suggest high-performance athletes may be a subgroup of patients for whom MR arthrography yields considerably more diagnostic information than conventional MRI.     

SLAP lesions of the glenoid labrum: CT arthrographic and arthroscopic correlation.

Tears in the superior part of the glenoid labrum in the anterior and posterior directions (SLAP, superior labrum anterior, posterior) result from injuries that place excessive stress on the tendon of the long head of the biceps brachii muscle. The intimate relationship of the tendon and the superior glenoid labrum promotes injury to the latter structure. Four types of SLAP lesions are seen at arthroscopy. Images from 17 patients with surgically proved SLAP lesions who had undergone preoperative computed tomographic (CT) arthrography were retrospectively reviewed to evaluate the value of CT arthrography in the detection and accurate depiction of these labral injuries. The authors compared the findings at videotaped arthroscopic surgery with those from CT arthrography and found that abnormalities of the labral-capsular apparatus could be detected with CT arthrography in 16 of the 17 patients. Furthermore, the CT arthrographic criteria developed during this review helped determine the type of tear in 15 of the 17 patients. CT arthrography appears to be useful in the evaluation of patients with suspected SLAP lesions.     

Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis

PURPOSE: To determine the reliability and accuracy of magnetic resonance (MR) arthrography for the diagnosis of superior labral anterior posterior (SLAP) tears. MATERIALS AND METHODS: The MR arthrograms in 80 patients who underwent arthroscopy and MR arthrography during a 54-month period were retrospectively reviewed. MR arthrograms were independently scored by three observers for the presence and type of SLAP lesion. Type I SLAP lesions were regarded as negative as they most often are not clinically relevant. Interobserver agreement for detection of SLAP lesions was calculated by using kappa coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate z score test. RESULTS: At arthroscopy, there were 25 SLAP tears: type II (n = 22), type III (n = 2), and type IV (n = 1). Sensitivity, specificity, and accuracy of each reader were 92%, 84%, and 86%; 92%, 82%, and 85%; and 84%, 69%, and 74%, respectively. Interobserver agreement for SLAP tears was substantial (kappa = 0.77) to moderate (kappa = 0.52, kappa = 0.44). The areas under the ROC curves for each reader were 0.94, 0.93, and 0.83, which were not significantly different. CONCLUSION: MR arthrography of the shoulder is reliable and accurate for detection of SLAP tears.     

Width of high signal and extension posterior to biceps tendon as signs of superior labrum anterior to posterior tears on MRI and MR arthrography

OBJECTIVE: The purpose of our study was to determine the accuracy of two signs for superior labrum anterior to posterior (SLAP) tears: increased width of high signal between the superior labrum and glenoid, and high signal posterior to the biceps tendon. MATERIALS AND METHODS: Forty-one patients with SLAP tears and 40 patients without a tear at surgery who had undergone MRI or MR arthrography were retrospectively evaluated. The MR studies were combined and interpreted in a blinded manner. The reviewers measured the width of high signal that extended to the articular surface on oblique coronal images and determined whether the high signal extended posterior to the biceps. A Student's t test was used to determine statistical significance between the means of the signal width. RESULTS: High-signal width was greater in patients with a SLAP tear than in the control group on both MRI and MR arthrography (both p = 0.003). The sensitivity and specificity of at least 2.0 mm on MRI are 39% (11/28) and 89% (24/27) and at least 2.5 mm on MR arthrography are 46% (6/13) and 85% (11/13). The sensitivity and specificity of high signal posterior to the biceps are 54% (15/28) and 74% (20/27) on MRI and 69% (9/13) and 54% (7/13) on MR arthrography. CONCLUSION: Increased width of high signal has a moderate specificity but a poor positive predictive value for distinguishing a SLAP tear from a normal recess. In addition, labral signal posterior to the biceps tendon is not rare in patients with no SLAP tear.     

Magnetic resonance arthrography assessment of the superior labrum using the BLC system: age-related changes mimicking SLAP-2 lesions

Objective

The purpose of the study was to describe the variation of the superior labrum with increasing age by assessing magnetic resonance (MR) arthrograms.

Methods

Inclusion criteria were used to include only the MR arthrograms of patients devoid of clinical labral pathology. Two hundred thiry-six MR arthrograms were blindly assessed for biceps-labral complex (BLC) type 1–3 and sublabral recess size by a musculoskeletal radiologist. We have chosen the BLC system, which defines normal superior labral variants, since it is established in the literature and is used by reporting musculoskeletal (MSK) radiologists.

Results

The MR arthrograms demonstrated that the majority of patients <40 years old were BLC type 1 and showed a steady increase in BLC types 2 and 3 with increasing age. Assessments demonstrated significantly greater (p?<?0.01) mean BLC types (1.62 vs 1.29) and recess size (1.35 vs 0.66 mm) in those over 40 compared with those less than 40 years of age. Furthermore, significant differences (p?<?0.05) were noted between mean BLC assessments between different decades of age.

Conclusions

There appears to be a physiologic deepening of the superior labrum sulcus with age, which becomes significant after the age of 40. These findings can contribute to whether the superior labrum is considered abnormal when assessed radiographically. The differentiation of normal age-related changes in the shoulder, from those of a type 2 SLAP tear can reduce the rates of unnecessary SLAP-2 repairs. This is the first reported series to use the BLC system; we believe it provides a common nomenclature to allow clear communication between specialists.     

Computed tomography (CT) arthrography of shoulder instabilities in athletes

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.     

Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears

OBJECTIVE: Our study correlated findings on hip MRI and MR arthrography with hip arthroscopy to assess the location, prevalence, and potential pitfall of a normal acetabular sublabral sulcus. MATERIALS AND METHODS: We retrospectively collected 58 hip MRI studies along with surgical reports in 58 patients who underwent hip arthroscopy over a 5-year period. Intraoperative photography (n = 23), radiography (n = 56), unenhanced MRI (n = 13), and MR arthrography (n = 54) studies were available for review. Two radiologists described hip anatomy on radiology studies with agreement by consensus. RESULTS: A normal posteroinferior sublabral groove was confirmed on available arthroscopy photographs in four (17.4%) of 23 hips. In each of these four patients, the anatomic sublabral groove correlated with apparent partial labral detachment on MR arthrography. On review of all studies, 13 hips (22.4%) without a posterior labral tear at surgery had imaging findings of a sublabral sulcus. The sulcus was not associated with acetabular dysplasia, which was radiographically noted in 12 cases (21.4%). Preoperatively, the sulcus was misdiagnosed as a tear in two cases. Labral tears were anterior or anterosuperior in 51 patients. CONCLUSION: A posteroinferior sublabral groove is a relatively common normal anatomic hip variation. If not recognized as normal, the sulcus may serve as a diagnostic pitfall on MR arthrography. Its location is distinct from most labral tears. We did not discover a sublabral sulcus at the anterior or anterosuperior acetabulum, the most common sites of labral injury.     

MR arthrographic findings of SLAP lesion type V

PURPOSE: The purpose of this study was to determine the findings of MR arthrography of the shoulder and to assess the role of MR arthrography in the diagnosis of superior labrum anterior to posterior (SLAP) lesion type V. METHODS AND MATERIALS: Two radiologists retrospectively reviewed fat-suppressed T1-weighted MR arthrography images of six patients who were diagnosed with SLAP lesion type V by arthroscopy. Each imaging plane, including the transverse, oblique coronal, oblique sagittal, and oblique transverse in abductor external rotation (ABER) position were evaluated for the following three findings: tear of the superior labrum at biceps tendon insertion, Bankart lesion, and continuity of the two former findings. RESULTS: Tear of the superior labrum was shown in all patients on oblique coronal images. Bankart lesion was noted in five patients on the transverse images and in four on the oblique sagittal images. On the oblique transverse images in ABER position, Bankart lesion was shown in all patients. The continuity of the two former findings was noted in three patients on the ABER positioned images. Therefore, three patients could be diagnosed as having SLAP lesion type V by MR arthrography in our series. CONCLUSION: It is difficult to detect all three findings of SLAP lesion type V in one imaging plane, however, a combination of multi-directional images may increase the feasibility of MR arthrography in diagnosing SLAP lesion type V.     

MR arthrography of the shoulder: comparison with conventional MR imaging

Twenty-three patients underwent both conventional MR imaging of the shoulder and MR shoulder arthrography for clinically suspected labral or rotator cuff abnormalities. Images obtained before and after contrast administration were studied independently, and without knowledge of clinical findings, by two radiologists for the presence of abnormalities of the glenoid labrum or rotator cuff. Results were correlated with surgical findings in all patients. Nine patients had surgically proved labral tears. MR arthrography detected all nine labral abnormalities, while six of the nine were missed on conventional MR imaging. Fourteen patients had surgically proved rotator cuff tears. MR arthrography detected 11 of the 14 tears and missed three partial tears on the bursal surface. Conventional MR imaging detected nine cuff tears and missed five tears; two of these were complete rotator cuff tears and three were partial tears of the undersurface of the rotator cuff. Our results suggest that MR arthrography enhances the accuracy of MR in the evaluation of the glenoid labrum and rotator cuff tendon.