Anterior Shoulder Instability: Accuracy of MR Arthrography in the Classification of Anteroinferior Labroligamentous Injuries

Waldt, Simone; Burkart, Andreas; Imhoff, Andreas B.; Bruegel, Melanie; Rummeny, Ernst J.; Woertler, Klaus

doi:10.1148/radiol.2372041429

Cited by 180 publications

(121 citation statements)

References 29 publications

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“…In our patients, MRA demonstrated the highest sensitivity at 94.4% among the groups in detecting Bankart lesions, which is similar to the results of studies (15)(16)(17), which advocate MRA as the gold standard for diagnosing anterior-inferior labral lesions. The advantages of MRA over other forms of imaging are the ability to detect subtle lesions of the intra-articular structures such as the labrum and ligaments (18).…”

Section: Discussionsupporting

confidence: 89%

Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging?

2016

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Background: Imaging modalities such as magnetic resonance arthrogram (MRA) offer great utility in diagnosing Bankart lesions but they are associated with a high degree of intra and interobserver variability. This study aims to evaluate the diagnostic accuracy of clinical evaluation and imaging modalities in Bankart lesions such as magnetic resonance imaging (MRI) and MRA of the shoulder. Conclusions: In our study, we report that clinical evaluation with focused history-taking and anterior apprehension, load and shift clinical examination can diagnose anterior shoulder instability as reliably as MR imaging. For patients with equivocal clinical findings, MR imaging can aid in the diagnosis.

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Section: Discussionsupporting

confidence: 89%

Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging?

2016

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“…Sensitivity and specificity values of the MRa were 89-96% and 84-89%, respectively. These results are consistent with the results of a previously published study of Waldt et al [8], evaluating 205 conventional MR arthrograms with arthroscopy as reference standard.…”

Section: Discussionsupporting

confidence: 92%

“…Direct magnetic resonance (MR) arthrography is considered to be the most accurate imaging technique for visualisation of the anteroinferior labroligamentous complex because of optimal joint distention with a diluted mixture of Gd-DTPA and superb soft tissue contrast [3][4][5][6][7][8][9][10].…”

mentioning

confidence: 99%

Is a single direct MR arthrography series in ABER position as accurate in detecting anteroinferior labroligamentous lesions as conventional MR arthography?

et al. 2009

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Purpose The purpose of this study is to retrospectively compare accuracy of single magnetic resonance (MR) arthrography series in Abduction External Rotation (ABER) with conventional MR arthrography for detection and characterisation of anteroinferior labroligamentous lesions, with arthroscopy as reference standard. Interobserver variability of both protocols was determined. Methods and materials Institutional review board approval was obtained; informed consent was waived. MR arthrograms, including oblique axial fat suppressed T1-weighted images in ABER position and conventional imaging directions of 250 patients (170 men, 80 women; mean age, 36 years), were retrospectively and independently evaluated by three reviewers. Reviewers were blinded to clinical information and arthroscopic results. Labroligamentous lesions were registered in both ABER and MRa. The lesions were sub-classified (Bankart, Perthes, anterior labrum periosteal sleeve avulsion (ALPSA) or lesions not otherwise specified). Inter-observer agreement was assessed by Kappa statistics for all 250 patients. Ninety-two of 250 patients underwent arthroscopy. Sensitivity, specificity and accuracy of ABER versus conventional MR arthrography were calculated and compared using paired McNemar test.Results Kappa values of the ABER and conventional MR arthrography ranged from 0.44 to 0.56 and 0.44 to 0.62, respectively. According to arthroscopy, 45 of 92 patients had an intact anteroinferior labrum, and in 44 patients, a labroligamentous lesion (eight Bankart, seven Perthes, 29 ALPSA and three lesions not otherwise specified) was diagnosed. There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (85-89%, 89-96%), specificity (82-91%, 84-89%) and overall accuracy (50-62%, 53-63%). Conclusion The results of a single MR arthrography series in ABER position are comparable with those of conventional MR arthrography for detecting anteroinferior labroligamentous lesions.

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“…Studies evaluating specific labral regions have reported sensitivities for superior and superior labrum anterior-posterior (SLAP) tears ranging from 50 to 100% [11][12][13][14][15]. Anteroinferior labral tears have been reported with a sensitivity of 88% [16], anterior tears 86-95% [11], and posterior tears 7.7%.…”

Section: Discussionmentioning

confidence: 99%

Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum

et al. 2007

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Objective The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears. Materials and methods Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional multi-echo data image combination, 2D MEDIC; and axial threedimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM Sonata 1.5-T MR system). Interpretations were correlated with operative reports. Results Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted tears in 16 (sensitivity 88% versus 64%; p<0.05). Subdividing the labrum, GRE was significantly more sensitive for the posterior labrum (75% versus 25%; p<0.05) with a trend toward greater sensitivity at the anterior labrum (78% versus 56%; p=0.157) but not significantly different for the superior labrum (50% versus 57%; p>0.7). Specificities were somewhat lower for GRE.Conclusion Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly smaller tears, in routine MR arthrography protocols.

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Anterior Shoulder Instability: Accuracy of MR Arthrography in the Classification of Anteroinferior Labroligamentous Injuries

Abstract: MR arthrography is accurate in enabling classification of acute and chronic anteroinferior labroligamentous injuries, although correct interpretation of Perthes lesions remains difficult.

Cited by 180 publications

References 29 publications

Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging?

Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging?

Is a single direct MR arthrography series in ABER position as accurate in detecting anteroinferior labroligamentous lesions as conventional MR arthography?

Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum

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