Accuracy of Abduction-External Rotation MRA Versus Standard MRA in the Diagnosis of Intra-articular Shoulder Pathology

Abstract

The goal of this study was to compare the accuracy of abduction-external rotation magnetic resonance arthrography (ABERMRA) with standard MRA in the diagnosis of intra-articular shoulder pathology.One hundred three consecutive patients undergoing preoperative direct MRA and subsequent arthroscopic examination were included in the study. Seventy-eight patients underwent standard MRA and 25 underwent ABERMRA. Specialist-trained musculoskeletal radiologists reported all scans, and attending shoulder surgeons performed all arthroscopies. Arthroscopic assessment revealed 11 partial-thickness rotator cuff tears, 3 full-thickness tears, 64 labral lesions (48 soft tissue and 16 significant bony), and 17 superior labrum anterior-posterior (SLAP) tears. The sensitivity/specificity for standard MRA was 0.56/0.99 for partial-thickness rotator cuff tears, 1.00/1.00 for full-thickness rotator cuff tears, 0.75/0.91 for soft tissue labral tears, 0.58/1.00 for significant bony glenoid lesions, and 0.50/0.91 for SLAP tears. Abduction-external rotation magnetic resonance arthrography increased the sensitivity/specificity to 1.00/0.85 for soft tissue labral tears, 0.75/1.00 for significant bony glenoid lesions, and 1.00/1.00 for SLAP tears, although it missed 2 of 2 partial-thickness rotator cuff tears.This study suggests that standard MRA is a valuable investigation tool for instability, SLAP tears, and rotator cuff tears, although limitations exist. Additional ABERMRA sequences appear to improve the diagnostic accuracy of soft tissue anterior and posterior labral tears, SLAP tears, and significant bony glenoid lesions and should be routinely requested by shoulder surgeons when ordering MRAs to obtain the maximum benefit from this invasive investigation.

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

“…This finding was supported in another study of 35 patients with glenoid bone loss where MR arthrograms were found to have good intra-and inter-observer reliability [43] . Both studies showed that MR arthrograms were comparable to 3D-CT. A study by Modi et al [44] with 103 patients reported that the sensitivity/specificity of MRA for glenoid bone loss was 0.58/1.00 and this increased to 0.75/1.00 when performing abduction external rotation views in addition to standard views.…”

Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis

“…Seven studies [29, 33, 37, 38, 40–42] claimed that the blinding method was used to assess the imaging modalities, while 2 studies [34, 35] did not clarify this fact. Among the included studies, 2 studies [37, 38] addressed the value of diagnostic test were evaluated by only 1 reader, 7 [29, 32–35, 40, 41] by 2 readers, and 1 [36] by 3 readers. Among the included studies, 11 studies [29, 33–42] claimed that shoulder arthroscopy was used as the gold standard.…”

“…Main technical parameters of MRA and MRI are presented in Table 3. According to the QUADAS-2 score, 4 (33.3%) [33, 37, 41, 42], 2 (16.7%) [29, 40], 4 (33.3%) [34–36, 39], 1 (8.3%) [32], and 1 (8.3%) [38] studies scored 11, 10, 9, 8, and 7, respectively (Table 1). Additional file 1: Table S1 shows the accuracy of MRA and MRI for the detection of bursal-sided partial-thickness RCTs.…”

Diagnostic Value of MRA and MRI for The Articular-Sided Partial-Thickness Rotator Cuff Tears: A Meta-Analysis

“…The screening of the reference lists of these and other relevant articles yielded 4 additional studies. After screening remaining titles and abstracts, and identifying related full-text, nally, 11 studies [18,[22][23][24][25][26][27][28][29][30][31] published during the period from 2007 to 2018 remained for quantitative analysis. The selection processes for the eligible studies are summarized in Figure 1.…”