Non-Contrast Magnetic Resonance Imaging for Diagnosing Shoulder Injuries

Abstract

purpose. To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears. Methods. 86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transvese, parasagittal, and paracoronar orientation. The sequences used were T2-and proton-weighted for paracoronar imaging, T1-and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors. results. For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could Non-contrast magnetic resonance imaging for diagnosing shoulder injuries Heino ArnoldOrthopaedisch -Unfallchirurgische Praxisklinik, Orrthopaedisches Zentrum Fichtelgebirge, Rehau, Germany Address correspondence and reprint requests to: Dr Heino Arnold, Orthopaedisch -Unfallchirurgische Praxisklinik, Orrthopaedisches Zentrum Fichtelgebirge, Bahnhofstrasse 10, 95111 Rehau, Germany. E-mail: orthopaedie_rehau@t-online.de 2012;20(3):361-4 not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively. conclusion. Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears. Journal of Orthopaedic Surgery

Prevalence of Shoulder Labral Injury in Collegiate Football Players at the National Football League Scouting Combine

“… 7 This discrepancy may be related to the fact that noncontrast MRI, as used in our study, is not considered the gold standard for diagnosing SLAP tears. 3 , 6 …”

High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders

“… 2 , 4 , 14 , 17 , 34 , 35 However, other studies have demonstrated that noncontrast MRI and MR arthrography are neither highly sensitive nor specific for the diagnosis of superior labral anterior posterior (SLAP) lesions. 1 , 3 , 7 , 15 , 26 , 28 …”

“…2,4,14,17,34,35 However, other studies have demonstrated that noncontrast MRI and MR arthrography are neither highly sensitive nor specific for the diagnosis of superior labral anterior posterior (SLAP) lesions. 1,3,7,15,26,28 Initially thought to be an uncommon entity, the incidence of SLAP lesion surgery has increased in the United States in the past decade. 23,34,36,38 Such studies have demonstrated that a significant contingent of patients undergoing SLAP lesion surgeries were middle-aged.…”

3-Tesla T2 Mapping Magnetic Resonance Imaging for Evaluation of SLAP Lesions in Patients with Shoulder Pain: An Arthroscopy-Controlled Study

“…The diagnostic performance of non-contrast MRI in superior labral tears has been studied several times, with variable results in terms of accuracy and sensitivity [24,25]. While some studies have reported high diagnostic accuracy for MR arthrography, others have demonstrated non-specific as well as non-sensitive results for MRI and MR arthrography in the diagnosis of SLAP lesions [26][27][28]. Early degenerative changes usually cannot be detected with conventional morphological MRI sequences; however, functional sequences such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2* mapping, and T2 mapping allow the assessment of the biochemical composition of joint structures [29][30][31].…”