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

Abstract

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.

Shoulder MR Arthrography Complication – Direct Injection of the Biceps Tendon: A Case Report

“…On higher field 3.0 Tesla MRI systems, non-contrasted MRI is generally performed as the initial evaluating imaging modality for SLAP tears, even in these younger patients. However, if the initial 3.0 Tesla MRI is negative or equivocal, as in our patient, arthrogram may increase sensitivity for SLAP diagnosis [5]. In selected clinical scenarios, arthrogram may also be useful for assessing full-thickness rotator cuff pathology, undersurface rotator cuff tearing, loose bodies and synovitis or to assess a post-surgical shoulder [6].…”

SSR white paper: guidelines for utilization and performance of direct MR arthrography

“…8 ). Multiple meta-analyses have shown that dMRA is more accurate than cMRI for the diagnosis of SLAP tears [ 181 , 182 , 191 , 192 ], with higher diagnostic accuracy at 3 T over 1.5 T with or without intra-articular contrast material [ 181 ]. One meta-analysis evaluating 3 T studies showed that dMRA was similar in sensitivity to cMRI (0.84 vs 0.83, p=.575), but less specific (0.99 vs 0.92 p < 0.0001) for SLAP lesions [ 177 ].…”

Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes

“…MRI has less sensitivity in detecting labral pathology as compared with MRI arthrogram. 8 The use of a 3-T magnet may differ from that used by some in practice, and thus our imaging, and incidence of detected abnormalities, may be different. In addition, there was no arthroscopic confirmation of the MRI findings, but the lack of surgical data simulates the decision-making assessment scenario, with just clinical and MRI findings.…”