Diagnostic performance of magnetic resonance arthrography of the shoulder in children

Chauvin, Nancy A.; Jaimes, Camilo; Ho-Fung, Víctor; Wells, Lawrence; Ganley, Theodore J.; Jaramillo, Diego

doi:10.1007/s00247-013-2685-2

Cited by 11 publications

(17 citation statements)

References 18 publications

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“…Conversely, Cordischi et al 1 reported that no Bankart lesions were evident on MRI or MRA. Further evidence from prospective studies which use investigations which have high rates of sensitivity and specificity for detecting Bankart lesions (such as MRA34) is required to establish the association between Bankart lesions and risk of recurrent instability in children aged under 18 years.…”

Section: Discussionmentioning

confidence: 99%

In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

et al. 2015

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Background Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability. Methods The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis. Results 6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and HillSachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14-18 years were 24 times more likely to experience recurrent instability than children aged 13 years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I 2 =6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I 2

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Section: Discussionmentioning

confidence: 99%

In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

et al. 2015

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“…Musculoskeletal radiologists exclusively interpreted the images in most studies (25 of 32). One study used musculoskeletal radiologists and orthopedic surgeons (14), one study used a combination of radiologists with and without formal musculoskeletal radiology training (6), one study used three pediatric radiologists with 24, 4, and 3 years of experience in musculoskeletal imaging (35), one study used one expert and one novice reader (25), one study used a radiologist who specialized in computed all studies). In terms of internal validity, 12 studies had no risk for bias, two had questionable risk for bias, and 18 had risk for bias in at least one of the following categories: patient selection, index test, reference standard, and flow and/or timing.…”

Section: Methodsmentioning

confidence: 99%

“…In terms of external validity, 100% (32 of 32) of the studies were applicable to clinical practice in terms of patient selection, the index test or tests used, and reference standard (arthroscopy in (35), no study exclusively included pediatric patients. The mean time to surgery (in the 18 of 32 studies where this information was available) for the MR imaging studies was 69 days, the mean time to surgery for the direct MR arthrography cohort was 57 days, and the mean time to surgery for the indirect MR arthrography cohort was 1 day.…”

Section: Critical Appraisal and Methodologic Qualitymentioning

confidence: 99%

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

et al. 2017

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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.

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“…The inferior two-thirds Bankart-type injuries, superior labral anteroposterior (SLAP) tears, and Hill-Sachs lesions. MR arthrography also has similar sensitivities and specificities for detecting such lesions in adolescent patients, in comparison with adults (21). Differences in chronic injuries for pediatric patients include the rare occurrence of rotator cuff pathologic conditions and the relatively high likelihood of finding labral pathologic conditions involving the posterior and superior labrum (four of every five injuries seen with shoulder arthroscopy) (22).…”

Section: Shoulder Injuriesmentioning

confidence: 99%

Imaging the Injured Pediatric Athlete: Upper Extremity

Delgado¹,

Jaramillo²,

Chauvin³

2016

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Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries. Acute injuries are more common in contact sports such as football and wrestling, whereas chronic injuries are often seen in baseball pitchers and gymnasts. Acute injuries unique to pediatric athletes include physeal fractures of the proximal and distal portions of the clavicle (periosteal sleeve fracture), the proximal humeral physis, and the coracoid process, as well as supracondylar, lateral condylar, and medial condylar fractures around the elbow. Chronic injuries, most commonly caused by repetitive microtrauma, include acromial apophyseolysis, Little Leaguer's shoulder, the constellation of findings seen in Little Leaguer's elbow, and injuries to the medial, lateral, and posterior elbow compartments. In addition, trochlear osteochondral lesions, gymnast's wrist, and rock climber's finger are less-common injuries that may be seen in children. In this article, the normal osseous development of the upper extremity is reviewed, with emphasis on the structures that are most commonly injured. The pathophysiology, imaging appearance, and imaging findings of pediatric athletic injuries are described, along with the prognostic implications. RSNA, 2016.

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Diagnostic performance of magnetic resonance arthrography of the shoulder in children

Abstract: There is no significant difference in the diagnostic accuracy of MR arthrography in skeletally immature versus skeletally mature children. MR shoulder arthrography is an effective method for the detection of labral and bone pathology.

Cited by 11 publications

References 18 publications

In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

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

Imaging the Injured Pediatric Athlete: Upper Extremity

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