Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy

Abstract

This study assessed the diagnostic effectiveness of multidetector spiral CT arthrography (MDCTa) in detecting hyaline cartilage abnormalities of the shoulder joint, with correlation to arthroscopy. Shoulder MDCTa images prospectively obtained in 22 consecutive patients (mean age, 50 years; age range, 23-74 years; 12 female, 10 male) were evaluated for glenohumeral cartilage lesions. Two musculoskeletal radiologists independently analysed the cartilage surfaces of the humeral head and of the glenoid fossa in nine anatomical surface areas. Observations of MDCTa were compared to arthroscopic findings. The sensitivity and specificity of MDCTa for grade 2 (substance loss <50%) or higher and grade 3 (substance loss >or=50%) or higher cartilage lesions, the Spearman correlation coefficient between arthrographic and arthroscopic grading, and K statistics for assessing Intra and Interobserver reproducibility were determined. At MDCTa, sensitivities and specificities ranged between 80% and 94% for the detection of grade 2 or higher cartilage lesions, and between 88% and 98% for the detection of grade 3 or higher cartilage lesions. Spearman correlation coefficients between MDCTa and arthroscopic grading of articular surfaces ranged between 0.532 and 0.651. Interobserver agreement was moderate for grading all articular surfaces (kappa = 0.457), but substantial to almost perfect for detecting lesions with substance loss (kappa, 0.618-0.876). In conclusion, MDCTa is accurate for the study of cartilage surface in the entire shoulder joint. This technique may beneficially impact patient's management by means of selecting the proper treatment approach.

Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation

“…Lecouvet et al evaluated the Data are sensitivity and specificity and accuracy (%) followed by 95 % confidence intervals in brackets. Pairwise comparisons between the diagnostic performance of techniques (CTA vs. MRA) and readers (reader 1 vs. reader 2) showed statistically significant differences for all comparisons: diagnostic performance of CTA was statistically significantly higher than MRA for reader 1 and 2 for the evaluation of all, glenoidal or humeral head cartilage lesions for both readers (all p≤0.04) [28]. One study by Acid et al, focusing on instability lesions, compared the diagnostic performance of CTA and MRA in assessing glenoid cartilage lesions in the same series of 40 patients [17].…”

Epinephrine-enhanced computed tomographic arthrography of the canine shoulder

“…In human literature, admixture of epinephrine and ionic contrast media is routine for CTA procedures of the joints when using diatrizoate meglumine (renografin, hypaque) (Rafii et al, 1986;McNiesh and Callaghan, 1987;Yang et al, 1987), iothalamate meglumine (Pennes et al, 1989) or ioxaglate meglumine (Hexabrix) (Vande Berg et al, 2000;Vande Berg et al, 2002;Mutschler et al, 2003;Lecouvet et al, 2007). Other investigators who use Ioxaglate meglumine (Hexabrix) for CTA do not add epinephrine.…”

“…However, no consensus has been established on the need for dilution, which mainly depends on the radiologists' preferences (Lecouvet et al, 2007). In this study, the contrast medium (Omnipaque 240) was diluted to 100 mg/ml with sterile saline (0.9% NaCl).…”

“…In human medicine, CTA of the shoulder is widely used to evaluate rotator cuff tears, and labral or capsular abnormalities, and to assess cartilage pathology (Rafii et al, 1986;Yang et al, 1987;De Maeseneer et al, 2000;Charousset et al, 2005;Lecouvet et al, 2007;Lecouvet et al, 2008;Omoumi et al, 2011). In veterinary medicine, CTA of the canine shoulder performed with a 4-slice helical CT-device, is used to evaluate the joint cartilage and intra-articular structures such as the glenohumeral ligaments and the BT (De Rycke et al, 2015).…”

Cartilage Morphology

“…23 Combined with three-dimensional reconstruction of the bone structure, useful information is yielded.…”