MR Arthrography of the Shoulder: Technical Update and Clinical Applications

Sebro, Ronnie; Oliveira, Adriana L.; Palmer, William E.

doi:10.1055/s-0034-1384825

Cited by 11 publications

(9 citation statements)

References 114 publications

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“…1 A previous study demonstrated 98% sensitivity and 96% specificity for MRI detection of full-thickness rotator cuff tears, as compared with arthroscopy.…”

Section: Introductionmentioning

confidence: 93%

Utility of pre- and post-MR arthrogram imaging of the shoulder: effect on patient care

Magee¹

2016

BJR

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Objective: MR arthrogram imaging of the shoulder is considered more accurate in assessing shoulder pathology than conventional MRI. Arthrography is a minimally invasive procedure. However, most patients prefer to have conventional MRI rather than MR arthrogram imaging. We report the benefit of assessing pre-arthrogram conventional MRI, to determine whether an MR arthrogram is needed for further evaluation. Methods: 100 consecutive conventional shoulder MR and MR arthrography examinations performed on the same patients were reviewed retrospectively by independent reading of 2 musculoskeletal radiologists. Both conventional MR and MR arthrogram examinations were performed on each patient on the same day. Conventional MR and MR arthrogram examinations were assessed for labral tears and supraspinatus tendon tears. All patients went on to arthroscopy. Results: Of these 100 patients, 43 patients had superior labral anterior to posterior (SLAP) tears, 28 patients had posterior labral tears, 23 patients had anterior labral tears and 47 patients had full-thickness supraspinatus tendon tears on conventional MR examination reading by Reader 1. There were 42 SLAP tears, 26 posterior labral tears, 24 anterior labral tears and 47 full-thickness supraspinatus tendon tears on conventional MR examination read by Reader 2. On MR arthrogram examination, 51 patients had SLAP tears, 33 patients had posterior labral tears, 29 patients had anterior labral tears and 49 patients had full-thickness supraspinatus tendon tears on reading by Reader 1. On MR arthrogram examination, 50 patients had SLAP tears, 31 patients had posterior labral tears, 30 patients had anterior labral tears and 49 patients had full-thickness supraspinatus tendon tears read by Reader 2. MR arthrogram detected eight SLAP tears, five posterior labral tears, six anterior labral tears and two supraspinatus tendon tears not detected on conventional MR examination read by Reader 1. MR arthrogram detected eight SLAP tears, five posterior labral tears, six anterior labral tears and two supraspinatus tendon tears not detected on conventional MR examination read by Reader 2. 18 of the 21 patients with additional finding on MR arthrogram examination had normal appearing conventional MR examinations. 1 A previous study demonstrated 98% sensitivity and 96% specificity for MRI detection of full-thickness rotator cuff tears, as compared with arthroscopy.2 High sensitivity and specificity for the detection of labral tears as compared with arthroscopy with 3-T MRI has been reported.3 High sensitivity and specificity for the detection of labral tears at 1.5 T has also been reported.

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“…1 A previous study demonstrated 98% sensitivity and 96% specificity for MRI detection of full-thickness rotator cuff tears, as compared with arthroscopy.…”

Section: Introductionmentioning

confidence: 93%

Utility of pre- and post-MR arthrogram imaging of the shoulder: effect on patient care

Magee¹

2016

BJR

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“…Findings suggestive of a SLAP tear include a high signal intensity that is globular, irregular or laterally curved into the substance of the labrum on coronal oblique images, an anterior to posterior linear hyperintense signal on axial T1-weighted MR arthrography (MRA), a signal of irregular width measuring > 2 mm. Because contrast material or joint fluid will extend under the free edge of a meniscoid-type superior labrum, it may be mistaken for a labral tear [ 1 3 4 11 14 21 25 26 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 ].…”

Section: The Labrummentioning

confidence: 99%

“…These anterosuperior variants may also predispose to superior labral lesions. Differentiating these normal variants from pathology is crucial because fixing the normal labrum and/or the middle glenohumeral ligament will result in loss of external rotation and surgical failure [ 1 3 9 14 25 30 32 33 34 35 36 37 38 39 40 44 46 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 ].…”

Section: The Labrummentioning

confidence: 99%

“…Traction on the labrum and inferior glenohumeral ligament in the ABER position (abduction of at least 90° with external rotation) increases the accuracy of MRA in case of an anteroinferior labral tear with minimal displacement. For an ALPSA-lesion, the FADIR position (full adduction with internal rotation) has been reported to help detection [ 35 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 ].…”

Section: What Shouldn’t We Miss In Patients With Recurrent Anterior Dmentioning

confidence: 99%

“…The Hill-Sachs lesion should not be confused posterosuperiorly with the bare area at the junction between the footprint of the infraspinatus and the articular cartilage nor posteroinferiorly with the flattened area of the normal humeral neck. On axial images, the Hill-Sachs lesion is typically found at the level of the coracoid process, whereas the neck is far below this level [ 1 35 68 72 77 80 84 85 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 ].…”

Section: What Shouldn’t We Miss In Patients With Recurrent Anterior Dmentioning

confidence: 99%

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What can the Radiologist do to Help the Surgeon Manage Shoulder Instability?

Pouliart

Doering

Shahabpour

2016

Journal of the Belgian Society of Radiology

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Imaging of the shoulder forms an important adjunct in clinical decision making in patients with shoulder instability. The typical lesions related with classic anterior and anteroinferior shoulder dislocation are an anteroinferior labral avulsion with or without bony fragment of bone loss – a (bony) Bankart lesion – and a posterolateral humeral head impaction fracture – the Hill-Sachs lesions. These are relatively straightforward to identify on imaging, although normal variants of the inferior labrum and variants of labral damage may cause confusion. Other capsuloligamentous lesions, often associated with less typical types of instability, are much more difficult to identify correctly on imaging, as they occur in the anterosuperior part of the glenohumeral joint with its many normal variants or because they result in more subtle, and therefore easily overlooked, changes in morphology or signal intensity. This paper aims at describing the appearance of the normal and pathologic glenohumeral joint related to shoulder instability. Ample reference will be given as to why identification of abnormalities, whether normal or pathologic, is important to the surgeon facing a treatment decision.

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