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Results for “Arthrography”

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At least 19 recordsLinked to original sources

PubMed1999

Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation.

OBJECTIVE: Conventional radiography, arthrography, CT arthrography, and MR arthrography--including use of the abduction and external rotation position--were compared, with arthroscopic correlation, to determine the spectrum of abnormalities encountered and the relative benefits of each imaging method in the evaluation of shoulder lesions occurring in 17 throwing athletes. SUBJECTS AND METHODS: Each of 36 athletes with shoulder pain aggravated by abduction and external rotation was examined in a single visit during which conventional radiography, arthrography, CT arthrography, and MR arthrography were performed. In 17 of these athletes, imaging findings were compared with those at arthroscopy. All images were independently evaluated by two groups of musculoskeletal radiologists. RESULTS: Structures found to be affected were, in decreasing order of frequency, the following: the posterosuperior labrum, supraspinatus tendon, infraspinatus tendon, humeral head, glenoid cavity and rim, acromioclavicular joint, anteroinferior capsulolabral complex, biceps tendon, and subscapularis tendon. MR arthrography without and with abduction and external rotation yielded the highest sensitivity and specificity for all lesions with the exceptions of bone sclerosis and enthesophytes (which were best seen with CT arthrography). MR arthrography with abduction and external rotation was most accurate for diagnosis of rotator cuff and anteroinferior capsulolabral complex tears. CONCLUSION: On the basis of these preliminary results, we believe that MR arthrography with abduction and external rotation should be part of the imaging evaluation of shoulder pain in throwing athletes, owing to the high sensitivity of this imaging technique.

Adult↗

PubMed1999

Evaluation of the postoperative meniscus of the knee: a study comparing conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material.

OBJECTIVE: To compare four imaging methods in the evaluation of the postoperative meniscus: conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material. DESIGN AND PATIENTS: Thirty-three patients referred for knee MR examinations with a history of meniscal surgery were studied prospectively. At the first patient visit, conventional MR examination was followed by an MR arthrogram with gadolinium-based contrast material. At the second visit, a conventional arthrogram with iodinated contrast material was followed immediately by an MR examination. Imaging examinations were interpreted by a masked reader, and then compared with the results of repeat arthroscopic surgery in 12 patients. RESULTS: The correct evaluation of the status of postoperative menisci was allowed in 12 of 13 patients (92%) by MR arthrography using gadolinium-based contrast agent, 10 of 13 patients (77%) by conventional MR examination, 9 of 12 patients (75%) by MR arthrography, and 7 of 12 patients (58%) by conventional arthrography. CONCLUSION: Intra-articular fluid is advantageous in the evaluation of patients with a suspected meniscal retear. MR arthrography with gadolinium-based contrast material is the most accurate imaging method for the diagnosis of meniscal retears.

Adult↗

PubMed1996

Imaging of osseous and cartilaginous intraarticular bodies in the knee: comparison of MR imaging and MR arthrography with CT and CT arthrography in cadavers.

PURPOSE: To compare magnetic resonance (MR) imaging and MR arthrography with computed tomography (CT) and CT arthrography in the detection of intraarticular bodies in the knee. MATERIALS AND METHODS: Cuboid (3- or 6-mm-long sides) osseous and cartilaginous bodies were implanted in 16 cadaveric knee specimens. MR imaging was performed with T1-weighted spin-echo (SE), T2-weighted SE, proton-density-weighted SE, gradient recalled acquisition in the steady state (GRASS), and spoiled GRASS sequences. MR arthrography was performed in two phases with saline and 2 mmol/L gadopentetate dimeglumine. CT and CT arthrography were performed in the transaxial plane. RESULTS: MR arthrography yielded the highest accuracy for the detection of osseous and cartilaginous bodies combined (92%) and was significantly (P < .01) better than MR imaging (57%-70%), CT arthrography (80%), and CT (74%). Accuracy of CT arthrography was significantly better than that of MR imaging and that of CT. Accuracy of saline-enhanced MR arthrography was significantly inferior (P < .001) to that of gadolinium-enhanced MR arthrography. CONCLUSION: MR arthrography is the best imaging technique for detection of individual intraarticular bodies. CT arthrography is the second most accurate method. Spoiled GRASS and T2-weighted SE sequences are the most accurate at MR imaging. The presence of intraarticular fluid and performance of saline-enhanced MR arthrography improve detectability of intraarticular bodies.

Arthrography↗

PubMed2005

Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow.

The objective of this study was to compare the value of multislice CT arthrography and MR arthrography in the assessment of cartilage lesions of the elbow joint. Twenty-six cadaveric elbow specimens were examined with the use of CT arthrography and MR arthrography prior to joint exploration and macroscopic inspection of articular cartilage. Findings at CT and MR arthrography were compared with macroscopic assessments in 104 cartilage areas. At macroscopic inspection, 45 cartilage lesions (six grade 2 lesions, 25 grade 3 lesions, 14 grade 4 lesions) and 59 areas of normal articular cartilage were observed. With macroscopic assessment as the gold standard CT and MR arthrography showed an overall sensitivity/specificity of 80/93% and 78/95% for the detection of cartilage lesions, respectively. Only two of six grade 2 lesions were detected by CT and MR arthrography. For the diagnosis of grade 3 and 4 lesions, the sensitivity/specificity was 87/94% with CT arthrography, and 85/95% with MR arthrography. In an experimental setting multislice CT arthrography and MR arthrography showed a similar performance in the detection of cartilage lesions. Both methods indicated limited value in the diagnosis of grade 2 articular cartilage lesions.

Aged↗

PubMed2003

Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography.

OBJECTIVE: To compare MR arthrography and CT arthrography for the evaluation of cartilage lesions in the ankle joint. DESIGN AND PATIENTS: Thirty-six consecutive patients with clinically suspected cartilage lesions were prospectively included in the study. A 1:1 mixture of diluted gadoteridol (4 mmol/l) and iopamidol (300 mg iodine/ml) was injected. The articular cartilages of the talus, tibia, and fibula were analyzed separately by two musculoskeletal radiologists. A review panel consisting of two musculoskeletal radiologists and an orthopedic surgeon represented the standard of reference. RESULTS: For reader 1 accuracy of MR arthrography in the talus/tibia/fibula (88%/88%/94%) was slightly inferior to CT arthrography (90%/94%/92%). For reader 2, the accuracy was 76%/78%/83% for MR arthrography, and 92%/93%/92% for CT arthrography, respectively. Interobserver agreement for MR arthrography was 79%/74%/89% (kappa 0.47/0.34/0.27), while interobserver agreement for CT arthrography was 89%/90%/89% (kappa 0.69/0.54/0.54). CONCLUSION: CT arthrography appears to be more reliable than MR arthrography for the detection of cartilage lesions in the ankle joint.

Adolescent↗

PubMed1999

Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional arthrography, conventional MRI, and MR arthrography.

PURPOSE: In a patient with internal derangement of the shoulder, the diagnostic method of choice is controversial. Conventional arthrography can diagnose most rotator cuff tears accurately; however, in many institutions MR arthrography is usually necessary to diagnose labral tears. We utilized decision tree methodology to compare the cost-effectiveness of conventional arthrography and conventional MRI with a hypothetical algorithm in which a patient underwent arthrography, performed with admixed gadolinium, which if negative, was followed by MRI. DESIGN: The use of double-contrast arthrography alone, conventional MRI alone, and gadolinium-enhanced MRI used as an adjunct to conventional arthrography were modeled for the diagnosis of full-thickness rotator cuff tears (RCT), partial RCTs, labral tears, and the absence of cuff/labral tears using decision analysis methodology. English language medical publications were searched to determine the base probabilities for the accuracy of the diagnostic tests. The outcome utilities ranged from -1 to +1 to reflect the value of correct diagnostic evaluation. Charges for diagnostic tests and appropriate surgical treatments were based on 1997 Medicare reimbursement rates for professional fees and hospital charges in an outpatient setting. Sensitivity analyses were performed to evaluate the effects of uncertainty regarding the prevalence of each disease state and the accuracy of several diagnostic tests. RESULTS: In the base-case analysis, the average effectiveness of double-contrast arthrography alone, MRI alone and arthrography selectively followed by MRI were 0.6610, 0.6715, and 0.7204, respectively. The average costs for each of these strategies were $1090, $2033, and $2339, respectively. CONCLUSION: Arthrography performed with admixed diluted gadolinium, which if negative is immediately followed by MRI, was somewhat more expensive than conventional MRI. However, because of much greater effectiveness, cost-effectiveness was significantly higher for our proposed algorithm. Conventional arthrography without gadolinium, although less expensive, had severely limited effectiveness.

Algorithms↗

PubMed1993

Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography.

OBJECTIVE: We prospectively compared MR imaging, MR arthrography, and CT arthrography to determine the sensitivity of each technique in detecting glenoid labral tears and in determining whether the labrum is detached or degenerated. SUBJECTS AND METHODS: Thirty patients 19-39 years old (mean, 27 years old) who had either signs and symptoms of shoulder instability or shoulder pain of unexplained origin were referred for diagnostic imaging. Each patient underwent MR imaging, followed by MR arthrography after intraarticular injection of 25 ml of a dilute solution of gadopentetate dimeglumine. Twenty-eight of thirty patients underwent CT arthrography after intraarticular injection of air and radiographic contrast material. Each patient also underwent arthroscopy or open surgery. RESULTS: At surgery, labral tears were found in 28 patients; a detached fragment was found in 26 patients. The labrum was found to be degenerated in 18. A labral tear was detected on MR images in 26 (93%) of 28, on MR arthrograms in 27 (96%) of 28, and on CT arthrograms in 19 (73%) of 26. A detached labral fragment was detected on MR images in 12 (46%) of 26, on MR arthrograms in 25 (96%) of 26, and on CT arthrograms in 13 (52%) of 25. Labral degeneration was detected on MR images in two (11%) of 18, on MR arthrograms in 10 (56%) of 18, and on CT arthrograms in four (24%) of 17. MR arthrography was the best of the three imaging techniques for showing the inferior part of the glenoid labrum and inferior glenohumeral ligament. CONCLUSION: MR arthrography and MR imaging both showed labral tears with greater sensitivity than CT arthrography did. MR arthrography was the most sensitive of the three techniques for detecting a detached labral fragment and labral degeneration. Furthermore, MR arthrography afforded the best visualization of the inferior part of the labrum and the inferior glenohumeral ligament. MR imaging and MR arthrography also enabled direct visualization of rotator cuff disease and other unsuspected associated abnormalities.

Adult↗

PubMed1998

Assessment of the superior labrum of the shoulder joint with CT-arthrography and MR-arthrography: correlation with anatomical dissection.

The ability to detect and categorize SLAP (Superior Labrum Anterior to Posterior) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is able to show normal anatomical variation of the glenoid labrum and detect labral abnormalities. CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.

Aged↗

PubMed2005

Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection.

The purpose of the present study was to evaluate the anatomical variability of the superior labrum and to compare the value of MR arthrography and multi-slice CT arthrography in the diagnosis of variants of the labro-bicipital complex. Forty-three human shoulder specimens (age range and mean age at death, 61-89 years and 78.3 years) were examined with the use of MR arthrography and multi-slice CT arthrography prior to joint exploration and macroscopic inspection of the superior labrum and labro-bicipital complex. Two radiologists evaluated MR and CT arthrograms, and the results were compared with macroscopic assessments. Anatomical dissection of all shoulder specimens revealed a sublabral recess in 32/43 (74%) cases. The attachment of the superior labrum was categorised as type 1 in ten (23%) cases, as type 2 in eight (19%), as type 3 in ten (23%), and as type 4 in 14 (33%) cases. One superior labrum showed detachment consistent with a superior labral anteroposterior (SLAP) type 3 lesion. On MR arthrography and CT arthrography the attachment of the superior labrum was categorised in concordance with macroscopic assessments in 79% and 84% of cases, respectively. The anteroposterior extension of sublabral recesses was accurately determined with MR and CT arthrography in 59% and 81% of cases, respectively. The attachment of the superior labrum shows considerable variability. Thus, exact depiction of variants is essential in order to avoid the false positive diagnosis of a superior labral tear (SLAP or Andrews lesion). Both, MR arthrography and multi-slice CT arthrography were effective in the detection and classification of sublabral recesses.

Aged↗

PubMed1998

Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers.

PURPOSE: To compare magnetic resonance (MR) arthrography with conventional arthrography and standard MR imaging in the evaluation of gamekeeper thumb. MATERIALS AND METHODS: Eighteen cadaveric thumbs with (n = 12) or without (n = 6) experimental abduction stress were examined with conventional arthrography, standard MR imaging, and MR arthrography. Standard MR imaging and MR arthrography were performed with 0.2-T (low-field-strength) extremity-only and 1.5-T (high-field-strength) magnets. Results of blinded imaging analyses were correlated with pathologic findings. Paired MR images and MR arthrograms were rated with a three-point scale. RESULTS: Fourteen ulnar collateral ligaments were torn, including eight nondisplaced (57%) and six displaced (43%) tears. For the presence of tear, diagnostic accuracy of conventional arthrography, low-field-strength MR imaging, high-field-strength MR imaging, low-field-strength MR arthrography, and high-field-strength MR arthrography was 83%, 89%, 90%, 94%, and 100%, respectively. With regard to displacement of the torn ligament, diagnostic accuracy was 61%, 89%, 90%, 94%, and 100%, respectively. MR arthrograms were rated superior to standard MR images in 72% and 90% of specimens with low-field-strength and high-field-strength magnets, respectively. CONCLUSION: Of the tested methods, MR arthrography proved to be the most sensitive to the diagnosis of a torn ulnar collateral ligament of the first metacarpophalangeal joint and of displacement of the torn ligament.

Aged↗

PubMed1994

Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.

OBJECTIVE: Chondromalacia patellae is a condition characterized by softening, fraying, and ulceration of patellar articular cartilage. We compare the sensitivity, specificity, and accuracy of conventional MR imaging, MR arthrography, and CT arthrography in detecting and staging this abnormality. SUBJECTS AND METHODS: Twenty-seven patients with pain in the anterior part of the knee were prospectively examined with MR imaging, including T1-weighted (650/16), proton density-weighted (2000/20), T2-weighted (2000/80), and spoiled two-dimensional gradient-recalled acquisition in the steady state (SPGR/)/35 degrees (51/10) with fat saturation pulse sequences. All were also examined with T1-weighted MR imaging after intraarticular injection of dilute gadopentetate dimeglumine and with double-contrast CT arthrography. Each imaging technique was evaluated independently by two observers, who reached a consensus interpretation. The signal characteristics of cartilage on MR images and contour abnormalities noted with all imaging techniques were evaluated and graded according to a modification of the classification of Shahriaree. Twenty-six of the 54 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity, and accuracy of each imaging technique in the diagnosis of each stage of chondromalacia patellae were determined and compared by using the McNemar two-tailed analysis. RESULTS: Arthroscopy showed that 28 facets were normal. Grade 1 chondromalacia patellae was diagnosed only with MR and CT arthrography in two (29%) of seven facets. Intermediate (grade 2 or 3) chondromalacia patellae was detected in two (13%) of 15 facets with T1-weighted and SPGR MR imaging, in three (20%) of 15 facets with proton density-weighted MR imaging, in seven (47%) of 15 facets with T2-weighted MR imaging, in 11 (73%) of 15 facets with CT arthrography, and in 12 (80%) of 15 facets with MR arthrography. Grade 4 was detected in three (75%) of four facets with T1-, proton density-, and T2-weighted MR imaging, two (50%) of four facets with SPGR MR imaging, and four (100%) of four facets with MR and CT arthrography. Thus, all imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesions, so that no significant difference among the techniques could be shown. CONCLUSION: All imaging techniques studied had high specificity and accuracy in the detection and grading of chondromalacia patella; however, both MR arthrography and CT arthrography were more sensitive than T1-weighted, proton density-weighted, and SPGR with fat saturation MR imaging for showing intermediate grades of chondromalacia patellae. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnoses was greatest with T2-weighted MR imaging.

Adult↗

PubMed2002

Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography.

PURPOSE: To prospectively investigate the accuracy of conventional magnetic resonance (MR) imaging, direct MR arthrography, and indirect MR arthrography in assessment of possible recurrent or residual meniscal tears. MATERIALS AND METHODS: Three hundred sixty-four patients who had previously undergone meniscal preservation surgery were prospectively examined with conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Ninety-four patients (104 postoperative menisci) underwent subsequent second-look arthroscopic surgery. Each case was evaluated for (a) surfacing intrameniscal intermediate- or T1-weighted signal intensity, (b) surfacing intrameniscal T2-weighted signal intensity, (c) morphologic changes beyond those expected postoperatively, (d) joint effusion on conventional MR or indirect MR arthrographic studies, and (e) overall presence or absence of recurrent meniscal tear. RESULTS: Seventy-one arthroscopically proved recurrent meniscal tears were found. In the diagnosis of recurrent meniscal tears, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 67%, 83%, 71%, and 80%, respectively, for conventional MR imaging; 83%, 78%, 90%, 64%, and 81%, respectively, for indirect MR arthrography; and 90%, 78%, 90%, 78%, and 85%, respectively, for direct MR arthrography. No significant difference in the diagnostic accuracy of one method relative to another was observed (P >.54). Surfacing intrameniscal T2-weighted signal intensity was the most specific sign, with the highest positive predictive value of a recurrent tear. CONCLUSION: Although a small incremental increase in accuracy is associated with the use of direct MR arthrography over conventional MR imaging and indirect MR arthrography, no significant difference in diagnostic accuracy among the three techniques was demonstrated for detection of recurrent or residual meniscal tear.

Adolescent↗

PubMed2004

The diagnostic value of digital subtraction arthrography and radionuclide arthrography in revision total hip arthroplasty.

An analysis of plain radiographs, digital subtraction arthrography, and radionuclide arthrography was performed in 25 revision hip arthroplasties to evaluate the efficacy and usefulness of these methods in the diagnosis of loosening. The findings by each method were compared with intraoperative assessment of the status of components and expressed in terms of sensitivity, specificity, and predictive accuracy. Overall accuracy for the acetabular component by plain radiographs was 80%; by digital subtraction arthrography, 88%; by radionuclide arthrography, 68%. Overall accuracy for the femoral component by plain radiographs was 92%; by digital subtraction arthrography, 84%; radionuclide arthrography, 76%. We consider subtraction arthrography and radionuclide arthrography to be adjuvant diagnostic tools which may be indicated in individual cases of suspected implant loosening of total hip arthroplasty. The routine use of these two methods is not warranted when compared to plain radiographs.

Arthrography↗

PubMed2005

Comparison of subtraction arthrography, radionuclide arthrography and conventional plain radiography to assess loosening of total knee arthroplasty.

The value of plain radiographs, digital subtraction arthrography and radionuclide arthrography was analysed in 23 cases of failed total knee arthroplasty. The preoperative diagnosis was compared with the intraoperative assessment. Sensitivity, specificity and the positive and negative predictive value for assessing a loose component were determined separately for the femoral and tibial components. At revision we found 13 loose femoral and 12 loose tibial implants. In eight cases both components were unstable. Plain radiography had a sensitivity of 77% for loosening of the femoral and 83% for the tibial component; digital subtraction arthrography 77% for the femoral and 8% for the tibial component and radionuclide arthrography 31% and 8%. The specificity for plain radiography was 90% for the femoral and 72% for the tibial implant. For subtraction arthrography it was 50% and 82% and for subtraction arthrography 70% and 82%. Radiography had the highest positive and negative predictive values for both components compared with the other two techniques. As a diagnostic tool to detect implant loosening, plain radiography is the most effective in this study. Subtraction arthrography and radionuclide arthrography are not suitable for use as routine methods for detection of total knee arthroplasty loosening.

Adult↗

PubMed2006

Diagnostic accuracy and interobserver variability of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in the assessment of aseptic femoral component loosening.

BACKGROUND: Plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy are imaging techniques commonly used to identify aseptic femoral component loosening. Controversy exists about the relative utility of these techniques. PATIENTS AND METHODS: We evaluated the diagnostic accuracy and interobserver reliability of the four techniques in 78 consecutive patients (mean age 70 years, range 29-88 years) referred for evaluation of their femoral hip prostheses. The standard evaluation protocol consisted of plain radiography followed by subtraction arthrography, nuclear arthrography, and bone scintigraphy. Surgery or the subsequent clinical course of the patient was used as gold standard. RESULTS: Overall, plain radiography had a sensitivity and specificity of 81 and 74%, respectively. Subtraction arthrography had a sensitivity of 47% and a specificity of 78%. Nuclear arthrography had a sensitivity of 69% and a specificity of 76%, and bone scintigraphy had a sensitivity of 88% with a specificity of 50%. CONCLUSION: We found considerable interobserver variability in all four techniques. Multivariate regression analysis revealed that bone scintigraphy and nuclear arthrography together made a significant contribution to the diagnosis when used in combination with plain radiography and are, when plain radiography is inconclusive, useful additional diagnostic techniques for the detection of femoral component loosening.

Adult↗

PubMed1997

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach.

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery. Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist.

Adolescent↗

PubMed1998

[The diagnostic accuracy and therapeutic relevance of CT arthrography and MR arthrography of the shoulder].

PURPOSE: In glenohumeral instability, CT arthrography and MR arthrography of the shoulder joint were compared to assess accuracy in diagnosis of labral lesions and other internal derangements of the joint, and to evaluate relevance of both imaging methods for therapy. METHODS: 38 patients with symptoms of shoulder instability were examined clinically, arthrographically with CT and MRI, and arthroscopically. Arthrography with CT and MRI was performed in a double-contrast technique after single puncture and simultaneous injection of the contrast agents for both imaging methods. Type and extent of lesions on arthrographic imaging were criteria for planning therapy to a conservative, sole arthroscopic, or open surgical approach. RESULTS: Sensitivity in diagnosis of labral lesion (26 defects) was 85% in CT, 88% in MRI and 100% if both methods were used. Full-thickness tears of the rotator cuff were visualised in CT in 73%, and in MRI in 100%. Diagnostic accuracy increased from partial to complete to total defects. An open surgical approach was correctly predicted on MRI in 90% and on CT in 71%. A sole arthroscopic therapy was correctly foreseen on both arthrographic techniques in only 38% due to difficulties to assess glenohumeral ligaments. CONCLUSIONS: CT arthrography and MR arthrography were excellent for diagnosing labral lesions. MRI is superior to CT in the imaging of all joint structures. Surgical approach can be accurately predicted with both imaging methods but special surgical techniques cannot be effectively planned to replace diagnostic arthroscopy in all cases.

Adult↗

PubMedDate not supplied

Comparison between conventional MR arthrography and abduction and external rotation MR arthrography in revealing tears of the antero-inferior glenoid labrum.

OBJECTIVE: To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. MATERIALS AND METHODS: MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. RESULTS: In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). CONCLUSION: MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.

Adolescent↗