A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder

Callaghan, John J.; McNiesh, Lawrence M.; Dehaven, James P.; Savory, Carlton G.; Polly, David W.

doi:10.1177/036354658801600103

Cited by 40 publications

(12 citation statements)

References 14 publications

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“…In a prospective study involving 30 patients aged 19±39 years and presenting shoulder instability or an explained painful shoulder syndrome, Chandnani demonstrated that CT arthrography, MRI and MR arthrography sensitivities in the diagnosis of labral tears were 73, 93 and 96 %, respectively. However, more recent studies indicate that MRI sensitivity varies from 19 to 95 %, and specificity from 78 to 93 % [35,45,46,47,48]. Therefore, it is difficult to assess whether standard MRI is more efficient than CT arthrography, the sensitivity and specificity of which vary, respectively, from 73 to 93 % and from 73 to 80 % [45,46].…”

Section: Capsulo-labral Detachmentsmentioning

confidence: 99%

“…However, more recent studies indicate that MRI sensitivity varies from 19 to 95 %, and specificity from 78 to 93 % [35,45,46,47,48]. Therefore, it is difficult to assess whether standard MRI is more efficient than CT arthrography, the sensitivity and specificity of which vary, respectively, from 73 to 93 % and from 73 to 80 % [45,46]. Taking into account these large variations in accuracy, many authors advocate the use of MR arthrography as the most reliable method with an accuracy in evaluating labro-cap-sular structures and detecting labral tears of approximately 90 % (Fig.…”

Section: Capsulo-labral Detachmentsmentioning

confidence: 99%

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Gleno-humeral instabilities

Blum¹,

Coudane

Molé

2000

European Radiology

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The purpose of this review is to highlight the most efficient imaging exploratory techniques depicting shoulder instability, to describe its various forms and to point out the findings which can simulate instability. In anterior recurrent dislocation, surgery is indicated and the procedure essentially depends on the importance of glenoid rim lesions. In this case, a standard X-ray evaluation is usually sufficient. The CT arthrography or MRI techniques give more specific details as to the severity of the lesions, particularly soft tissues alterations; however, these data do not alter standard therapeutic protocol. In fixed posterior dislocations, CT scan represents the most pertinent technique to evaluate the size of the humeral head defect and to determine the therapeutic follow-up. In subtle forms of instability, diagnosis or instability direction are not clearly assessed clinically and standard X-ray evaluation is usually unremarkable. In this case, further exploration, such as CT arthrography, MR imaging or MR arthrography, are recommended to confirm the diagnosis of instability and to evaluate its direction. The technique of choice is undoubtedly MR arthrography. Atraumatic voluntary painless subluxations associated with hyperlaxity of the shoulder do not require any specific exploratory method because the findings are generally limited to a capacious axillary pouch.

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Section: Capsulo-labral Detachmentsmentioning

confidence: 99%

Section: Capsulo-labral Detachmentsmentioning

confidence: 99%

Gleno-humeral instabilities

Blum¹,

Coudane

Molé

2000

European Radiology

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“…14 The CT arthrography reportedly has been successful in about 80% to 100% of the cases, but it is known to be ineffective in detecting small labral tears or detachments. 1,5,6,17,19,23,29,39,41,[43][44][45]53,56 Double-contrast CT arthrography may be more precise in delineating labral injury. 1,5 These are invasive procedures that require the injection of contrast material into the shoulder and the use of ionizing radiation.…”

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confidence: 99%

Magnetic Resonance Imaging of the Glenoid Labrum in Anterior Shoulder Instability

Green

Christensen

1994

Am J Sports Med

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Detachment of the anterior inferior labrum and inferior glenohumeral ligament complex from the glenoid is a common lesion encountered in anterior shoulder instability while other types of labral lesions are associated with symptoms that mimic instability. Accurate delineation of labral lesion is, therefore, key in managing shoulder problems. In a prospective double-blinded fashion, we compared the magnetic resonance imaging findings with those noted at surgery in 33 patients with possible anterior shoulder instability. Of 28 surgically confirmed labral lesions, 21 were detected by imaging. Sensitivity was 75%, specificity 100%, while positive and negative predictive values were 100% and 41%, respectively. Overall accuracy was 79%. Based on a literature review and our clinical experience, we developed a classification of glenoid labra according to the type and severity of the lesions. Method of treatment correlated with clinical outcome, using this system, to a statistically significant level. Unfortunately, this system enabled accurate classification with magnetic resonance imaging in only 7 of 33 (21%) labra, with the precision necessary to affect surgical planning in our series. We conclude that magnetic resonance imaging is not useful in the surgical planning for most patients with obvious anterior shoulder instability.

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“…The accuracy for detection of labral pathology using CT arthrography has been reported to be high (85% to 100%); however, much of the original research is decades old and our understanding of labral pathology is more sophisticated today. [15][16][17][18][19] Paralabral cysts are more difficult to see on CT than MRI because the cysts are similar in attenuation to adjacent rotator cuff musculature. Contrast from the arthrogram can fill these cysts via labral tears, but the flow of fluid is slow and the presence of contrast in a cyst is discovered by looking carefully for a wispy contrast collection outside the normal confines of the joint space.…”

Section: Ct Arthrographymentioning

confidence: 99%

Current Concepts and Advances

Buckwalter¹

2009

Sports Medicine and Arthroscopy Review

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Computed tomography (CT) is a widely used imaging technique. With the introduction of multidetector row technology, CT has been further refined. Although the focus of this transformation has been body and cardiac imaging, orthopedic imaging has benefited greatly. Specifically, the improvements in CT have made it possible to obtain submillimeter-thick slices that enable the creation of high-resolution multiplanar reformations from a single scan. These images usually are indistinguishable from direct plane acquisitions and provide unparalleled detail. Additionally, the factors responsible for causing CT image artifacts when hardware is present are much better understood and the improvements in CT technique and technology can be exploited to provide better images of patients with orthopedic hardware. The detailed multiplanar visualization of joints facilitates CT arthrography that has undergone a renaissance. CT arthrography is useful in the very large athlete or patient, the claustrophobic, and for those patients who fail a conventional magnetic resonance examination or magnetic resonance arthrogram.

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A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder

Cited by 40 publications

References 14 publications

Gleno-humeral instabilities

Gleno-humeral instabilities

Magnetic Resonance Imaging of the Glenoid Labrum in Anterior Shoulder Instability

Current Concepts and Advances

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