Diagnosis of Superior Labrum Anterior-to-Posterior Tears by Using MR Imaging and MR Arthrography: A Systematic Review and Meta-Analysis

Abstract

Purpose To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Materials and Methods A comprehensive literature search was performed on the two main concepts of MR imaging (MR imaging, and direct and indirect MR arthrography) and SLAP tears. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR imaging, direct MR arthrography, and/or indirect MR arthrography for the detection of SLAP tears, by using surgical findings as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool was used to assess methodologic quality. Meta-analyses were performed that compared MR imaging studies to direct MR arthrography studies and indirect MR arthrography studies, 3-T studies to 1.5-T studies, and low-bias MR imaging studies to low-bias direct MR arthrography studies. Study variation was analyzed by using the Cochran Q test of heterogeneity and the I statistic. Results Thirty-two studies met inclusion and exclusion criteria, including 3524 imaging examinations: 1963 direct MR arthrography examinations (23 studies), 1402 MR examinations (14 studies), and 159 indirect MR arthrography examinations (three studies). Twelve studies had low risk for bias, two had questionable risk, and 18 had high risk. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Conclusion Direct MR arthrography appears to be more accurate than nonenhanced MR imaging for diagnosis of SLAP tears, whereas 3-T MR imaging with or without intra-articular contrast material appears to improve diagnostic accuracy compared with 1.5-T MR imaging with or without intra-articular contrast material. RSNA, 2017 Online supplemental material is available for this article.

Best practices for MRI systematic reviews and meta‐analyses

“…For example, in imaging studies, if the index test is not interpreted based on a specific threshold, it may not be worthwhile considering this particular issue. The apparent diffusion coefficient (ADC) threshold would be relevant in DWI to indicate the presence or absence or degree of restricted diffusion and thus this signaling question would be relevant; however, in detection of labrum tears threshold effects may not be relevant . Upon agreement of the reviewers with regard to the content of the tool, two independent investigators should perform a quality assessment pilot process.…”

“…Magnetic resonance imaging (MRI) is a powerful diagnostic tool and with a wide array of clinical, mainly diagnostic, applications . While MRI‐guided procedures (interventional MRI) began in the 1990s, image‐guided interventions are still dominated by ultrasound, fluoroscopy, and computed tomography (CT) .…”

“…Systematic reviews can be used to aggregate data from multiple relatively small or underpowered studies to provide a more precise and more informative estimate of the effectiveness of an intervention or the accuracy of a diagnostic test. 4,5 Additionally, meta-analysis may explore sources of heterogeneity among the observed effects of an intervention or the accuracy of a diagnostic test. 2,3 There are several fundamental differences between systematic reviews of randomized trials of interventions and reviews of test accuracy studies.…”

“…Magnetic resonance imaging (MRI) is a powerful diagnostic tool and with a wide array of clinical, mainly diagnostic, applications. [2][3][4][5][6][7][8][9][10] While MRI-guided procedures (interventional MRI) began in the 1990s, image-guided interventions are still dominated by ultrasound, fluoroscopy, and computed tomography (CT). 11 There are several challenges to MR-guided interventions, such as longer acquisition times, increased cost of MRI-safe equipment, and the technical complexity of performing a procedure within a superconducting MRI system.…”

What is a symptomatic SLAP II tear? It is all about inclusion and exclusion criteria

“…Based on several publications, it is known that although there are some subtle MRI arthrographic findings, it is still difficult to differentiate between type II SLAP lesions and a ‘physiologic’ superior sublabral recess 9. A 3T MRI scan is proven more reliable in diagnosing a SLAP lesion compared with a 1.5 T MRI scan 10. Dynamic labral tear test or the ‘peel back’ phenomenon can be used during arthroscopy to differentiate, but then still it is not known if the lesion is symptomatic 11…”