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Hamel C, Avard B, Gorelik N, Heroux M, Mai D, Sheikh A, Vo A, Watson ML, Rakhra K. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:269-278. [PMID: 37635274 DOI: 10.1177/08465371231190807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Musculoskeletal System Expert Panel consists of musculoskeletal radiologists, a family physician, a sports and exercise medicine physician, emergency medicine physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 25 musculoskeletal clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for 1 or more of these clinical/diagnostic scenarios. Recommendations from 41 guidelines (50 publications) and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 124 recommendation statements across the 25 scenarios related to the evaluation of the musculoskeletal system. This guideline presents the methods of development and the recommendations for imaging in the context of musculoskeletal pain, infection, tumors, arthropathies, metabolic bone disease, stress injuries, orthopedic hardware, avascular necrosis/bone infarction, and complex regional pain syndrome.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Natalia Gorelik
- Department of Radiology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adnan Sheikh
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | - Kawan Rakhra
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Kuhn I, Erber B, Goller SS. [Adhesive capsulitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Stanborough RO, Garner HW, Simovitch RW, Schoch BS. Magnetic Resonance Imaging of the Shoulder: Interpretation of Common Orthopaedic Injuries. J Am Acad Orthop Surg 2024; 32:e73-e83. [PMID: 37862697 DOI: 10.5435/jaaos-d-22-01153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/20/2023] [Indexed: 10/22/2023] Open
Abstract
Magnetic resonance imaging (MRI) is frequently obtained to assess for pathology in the setting of shoulder pain and dysfunction. MRI of the shoulder provides diagnostic information that helps optimize patient management and surgical planning. Both general and subspecialized orthopaedic surgeons routinely order and review shoulder MRIs in practice. Therefore, familiarity with the MRI appearance of common shoulder pathologies is important. This document reviews the most common shoulder pathologies using a standardized MRI interpretative approach. Instructional videos demonstrating a musculoskeletal radiologist interpreting normal and abnormal shoulder MRIs are also provided.
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Affiliation(s)
- Rupert O Stanborough
- From the Radiology Department, Mayo Clinic, Jacksonville (Stanborough, and Garner), the Orthopedic Surgery Department, Hospital for Special Surgery, Palm Beach (Simovitch), and the Orthopedic Surgery Department, Mayo Clinic, Jacksonville, FL (Schoch)
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Mabry LM, Keil A, Young BA, Reilly N, Ross MD, Gisselman AS, Goss D. Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study. J Man Manip Ther 2023:1-11. [PMID: 38130076 DOI: 10.1080/10669817.2023.2296260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. METHODS This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency. RESULTS Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). DISCUSSION/CONCLUSION There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.
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Affiliation(s)
- Lance M Mabry
- Department of Physical Therapy, High Point University Congdon School of Health Sciences, High Point, NC, USA
| | - Aaron Keil
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian A Young
- Department of Physical Therapy, Baylor University, Waco, TX, USA
| | - Nicholas Reilly
- Department of Physical Therapy, High Point University Congdon School of Health Sciences, High Point, NC, USA
| | - Michael D Ross
- Department of Physical Therapy, Daemen University, Amherst, NY, USA
| | | | - Don Goss
- Department of Physical Therapy, High Point University Congdon School of Health Sciences, High Point, NC, USA
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Dehlinger F, Bökeler U, Brandt H, Brunnader L, Eden L, Pfingsten A, Prill R. The S2e Guideline on Shoulder Stiffness. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37798915 DOI: 10.1055/a-2123-4952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The clinical picture of "frozen shoulder" is still poorly understood. In order to present the current state of knowledge on aetiology, diagnosis, and treatment, and to provide recommendations for the professional groups involved, a working group was formed by the DGOU and the DVSE to create a German language, evidence-based guideline, which was published in 2022 by the AWMF. The following summarises the development and the most important results.
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Affiliation(s)
- Friedrich Dehlinger
- Departement for Shoulder and Elbow Surgery, Acura Fachklinik GmbH, Albstadt, Deutschland
| | - Ulf Bökeler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Zentrum für Schwerbrandverletzte, Marien Hospital Stuttgart, Stuttgart, Deutschland
| | - Hanna Brandt
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Lars Brunnader
- Abteilung für Orthopädie und Traumatologie, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Deutschland
| | - Lars Eden
- Klinik für Unfall-, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck, Deutschland
| | - Andrea Pfingsten
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Deutschland
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Deutschland
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Zeldin ER, Boyette DM, Norbury JW. Shoulder Pain After Influenza Vaccine Administration: A Clinical Vignette. Am J Phys Med Rehabil 2023; 102:e141-e143. [PMID: 37026846 DOI: 10.1097/phm.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Evan R Zeldin
- From the Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina (ERZ); Boyette Orthopedics and Sports Medicine, Greenville, North Carolina (DB); and Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (JWN)
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Puel U, Lombard C, Hossu G, Louis M, Blum A, Teixeira PAG, Gillet R. Zero echo time MRI in shoulder MRI protocols for the diagnosis of rotator cuff calcific tendinopathy improves identification of calcific deposits compared to conventional MR sequences but remains sub-optimal compared to radiographs. Eur Radiol 2023; 33:6381-6391. [PMID: 37014406 DOI: 10.1007/s00330-023-09602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of standard MRI and standard MRI + ZTE images for the detection of rotator cuff calcific tendinopathy (RCCT) and to describe the artifacts encountered with ZTE images, using computed radiography (CR) as a reference. METHODS In a retrospective study, patients with suspicion of rotator cuff tendinopathy who underwent standard MRI + ZTE images after radiography were enrolled between June 2021 and June 2022. Images were independently analyzed for calcific deposit presence and ZTE images artifacts, by two radiologists. Diagnostic performance was calculated individually with MRI + CR as the reference standard. RESULTS A total of 46 RCCT subjects (27 women; mean age, 55.3 years ± 12.4) and 51 control subjects (27 men; mean age, 45.5 ± 12.9) were evaluated. For both readers, there was an increase in the sensitivity for the identification of calcific deposits of MRI + ZTE compared to MRI (77% (95% CI: 64.5-86.8) and 75.4% (95% CI: 62.7-85.5) versus 57.4% (95% IC: 44.1-70) and 47.5% (95% IC: 34.6-60.7), for R1 and R2, respectively). Specificity was quite similar for both readers and both imaging techniques and ranged from 96.6% (95% IC: 93.3-98.5) to 98.7% (95% IC: 96.3-99.7). Hyperintense joint fluid (62.8% of patients), long head of the biceps tendon (in 60.8%), and subacromial bursa (in 27.8%) on ZTE were considered artifactual. CONCLUSION The addition of ZTE images to a standard MRI protocol improved MRI diagnostic performance of RCCT, but with a suboptimal detection rate and a relatively high frequency of artifactual soft tissue signal hyperintensity. KEY POINTS • Adding ZTE images to standard shoulder MRI improves the MR-based detection of rotator cuff calcific tendinopathy, but half of the calcification unseen with standard MRI remained unseen with ZTE MRI. On ZTE images, joint fluid and long head biceps tendon were hyperintense in about 60% of the shoulders, as well as the subacromial bursa in about 30%, without calcific deposit on conventional radiographs. • The detection rate of calcific deposits using ZTE images was dependent on the disease phase. In the calcific stage, it reached 100% in this study but remained at a maximum of 80.7% in the resorptive phase.
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Affiliation(s)
- Ulysse Puel
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Charles Lombard
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- CIC, Innovation Technologique, Université de Lorraine, University Hospital Center of Nancy, Nancy, France
| | - Mathias Louis
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France.
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
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Update on Diagnostic Imaging of the Rotator Cuff. Clin Sports Med 2023; 42:25-52. [DOI: 10.1016/j.csm.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kaniewska M, Deininger-Czermak E, Getzmann JM, Wang X, Lohezic M, Guggenberger R. Application of deep learning-based image reconstruction in MR imaging of the shoulder joint to improve image quality and reduce scan time. Eur Radiol 2023; 33:1513-1525. [PMID: 36166084 PMCID: PMC9935676 DOI: 10.1007/s00330-022-09151-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the image quality and diagnostic performance of conventional motion-corrected periodically rotated overlapping parallel line with enhanced reconstruction (PROPELLER) MRI sequences with post-processed PROPELLER MRI sequences using deep learning-based (DL) reconstructions. METHODS In this prospective study of 30 patients, conventional (19 min 18 s) and accelerated MRI sequences (7 min 16 s) using the PROPELLER technique were acquired. Accelerated sequences were post-processed using DL. The image quality and diagnostic confidence were qualitatively assessed by 2 readers using a 5-point Likert scale. Analysis of the pathological findings of cartilage, rotator cuff tendons and muscles, glenoid labrum and subacromial bursa was performed. Inter-reader agreement was calculated using Cohen's kappa statistic. Quantitative evaluation of image quality was measured using the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). RESULTS Mean image quality and diagnostic confidence in evaluation of all shoulder structures were higher in DL sequences (p value = 0.01). Inter-reader agreement ranged between kappa values of 0.155 (assessment of the bursa) and 0.947 (assessment of the rotator cuff muscles). In 17 cases, thickening of the subacromial bursa of more than 2 mm was only visible in DL sequences. The pathologies of the other structures could be properly evaluated by conventional and DL sequences. Mean SNR (p value = 0.01) and CNR (p value = 0.02) were significantly higher for DL sequences. CONCLUSIONS The accelerated PROPELLER sequences with DL post-processing showed superior image quality and higher diagnostic confidence compared to the conventional PROPELLER sequences. Subacromial bursa can be thoroughly assessed in DL sequences, while the other structures of the shoulder joint can be assessed in conventional and DL sequences with a good agreement between sequences. KEY POINTS • MRI of the shoulder requires long scan times and can be hampered by motion artifacts. • Deep learning-based convolutional neural networks are used to reduce image noise and scan time while maintaining optimal image quality. The radial k-space acquisition technique (PROPELLER) can reduce the scan time and has potential to reduce motion artifacts. • DL sequences show a higher diagnostic confidence than conventional sequences and therefore are preferred for assessment of the subacromial bursa, while conventional and DL sequences show comparable performance in the evaluation of the shoulder joint.
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Affiliation(s)
- Malwina Kaniewska
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Raemistrasse 100, CH-8091, Zurich, Switzerland. .,University of Zurich (UZH), Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Eva Deininger-Czermak
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Jonas M. Getzmann
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Xinzeng Wang
- grid.418143.b0000 0001 0943 0267Global MR Applications & Workflow, GE Healthcare, Houston, TX USA
| | - Maelene Lohezic
- grid.420685.d0000 0001 1940 6527Applications & Workflow, GE Healthcare, Manchester, UK
| | - Roman Guggenberger
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland
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Editorial Comment: Postoperative Imaging of the Rotator Cuff-Do We Have to Choose? AJR Am J Roentgenol 2022; 219:723. [PMID: 35703416 DOI: 10.2214/ajr.22.28100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Image Quality and Diagnostic Performance of Accelerated Shoulder MRI With Deep Learning-Based Reconstruction. AJR Am J Roentgenol 2021; 218:506-516. [PMID: 34523950 DOI: 10.2214/ajr.21.26577] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Shoulder MRI using standard multiplanar sequences requires long scan times. Accelerated sequences have tradeoffs in noise and resolution. Deep learning-based reconstruction (DLR) may allow reduced scan time with preserved image quality. Objectives: To compare standard shoulder MRI sequences and accelerated sequences without and with DLR in terms of image quality and diagnostic performance. Methods: This retrospective study included 105 patients (45 men, 60 women; mean age 57.6±10.9 years) who underwent a total of 110 3-T shoulder MRI examinations. Examinations included standard sequences (scan time, 9 minutes 23 seconds) and accelerated sequences (3 minutes 5 seconds; 67% reduction), both including fast spin echo sequences in three planes. Standard sequences were reconstructed using the conventional pipeline; accelerated sequences were reconstructed using both conventional pipeline and a commercially available DLR pipeline. Two radiologists independently assessed three image sets (standard, accelerated without DLR, accelerated with DLR) for subjective image quality and artifacts using 4-point scales (4=highest quality), and identified pathologies of subscapularis tendon, supraspinatus-infraspinatus tendon, biceps brachii long head tendon, and glenoid labrum. Interobserver and inter-image set agreement for the evaluated pathologies was assessed using weighted kappa statistics. In 27 patients who underwent arthroscopy, diagnostic performance was calculated using arthroscopic findings as reference. Results: Mean subjective image quality for readers 1 and 2 was 10.6±1.2 and 10.5±1.4 for standard, 8.1±1.3 and 7.2±1.1 for accelerated without DLR, and 10.7±1.2 and 10.5±1.6 for accelerated with DLR. Mean artifact score for readers 1 and 2 was 9.3±1.2 and 10.0±1.0 for standard, 7.3±1.3 and 9.1±0.8 for accelerated without DLR, and 9.4±1.2 and 9.8±0.8 for accelerated with DLR. Interobserver agreement ranged from kappa=0.813-0.951 except for accelerated without DLR for SST-IST (κ=0.673). Inter-image set agreement ranged from kappa=0.809-0.957 except for reader 1 for SST-IST (κ=0.663-0.700). Accuracy, sensitivity, and specificity for tears of the four structures was not different (p>.05) among image sets. Conclusions: Accelerated sequences with DLR provide 67% scan time reduction with similar subjective image quality, artifacts, and diagnostic performance as standard sequences. Clinical impact: Accelerated sequences with DLR may provide an alternative to standard sequences for clinical shoulder MRI.
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Ladd LM, Crews M, Maertz NA. Glenohumeral Joint Instability: A Review of Anatomy, Clinical Presentation, and Imaging. Clin Sports Med 2021; 40:585-599. [PMID: 34509200 DOI: 10.1016/j.csm.2021.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The glenohumeral joint is intrinsically predisposed to instability because of the bony anatomy but maintained in alignment by many important structures, including the glenoid labrum, glenohumeral ligaments (GHLs), and muscles and tendons. Trauma and overuse can damage these stabilizers, which may then lead to subluxation or dislocation and eventually recurrent instability. This is most common in the anterior direction, which has several recognizable patterns of injury on advanced imaging, including humeral Hill Sachs deformities, bony Bankart lesion of the anteroinferior glenoid, soft tissue Bankart lesions, Bankart variant lesions (Perthes and ALPSA lesions), and HAGL/GAGL lesions. Similar reverse lesions are seen, as well as unique posterior lesions, such as Bennett and Kim's lesions. When symptoms of apprehension and instability in more than one direction are seen, one should consider multidirectional instability, which often presents with a patulous joint capsule. Finally, owing to significant impacts of daily activities and quality of life, surgical correction of labral tears, bony Bankart defects, Hill Sachs defects, and capsular laxity, may be considered.
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Affiliation(s)
- Lauren M Ladd
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 1701 N. Senate Boulevard, Indianapolis, IN 46202, USA.
| | - Marlee Crews
- Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, USA
| | - Nathan A Maertz
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 1701 N. Senate Boulevard, Indianapolis, IN 46202, USA
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Gillet R, Zhu F, Padoin P, Rauch A, Hossu G, Teixeira PAG, Blum A. MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study. J Clin Med 2021; 10:jcm10173882. [PMID: 34501330 PMCID: PMC8432015 DOI: 10.3390/jcm10173882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. PURPOSE To determine the correlation of MRI findings with the Constant-Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients. MATERIALS AND METHODS This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment. RESULTS There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05). CONCLUSIONS In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.
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Affiliation(s)
- Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
- Correspondence: ; Tel.: +33-3-83-85-21-61; Fax: +33-3-83-85-97-25
| | - François Zhu
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Pierre Padoin
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Gabriela Hossu
- CIC-IT, CHRU Nancy, Université de Lorraine, 54000 Nancy, France;
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
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Motamedi D, Bauer AH, Patel R, Morgan TA. Problem Solved: Integral Applications of Musculoskeletal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1693-1704. [PMID: 33155690 DOI: 10.1002/jum.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/09/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
Musculoskeletal ultrasound has grown substantially in use over the past several years as an indispensable companion to magnetic resonance imaging and other imaging modalities. This article reviews 10 integral applications of musculoskeletal ultrasound as a problem-solving tool with correlative case examples. These applications include the following: (1) accessibility and portability, (2) targeted imaging, (3) dynamic imaging, (4) contralateral comparison, (5) Doppler imaging, (6) increased spatial resolution, (7) solid versus cystic comparison, (8) posttraumatic imaging, (9) postsurgical imaging, and (10) treatment delivery and optimization. The review will help the radiologist recognize the complementary uses of musculoskeletal ultrasound with radiography, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Adam H Bauer
- Department of Radiology, Kaiser Fontana Medical Center, Fontana, California, USA
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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15
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The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries. AJR Am J Roentgenol 2021; 217:1390-1400. [PMID: 34161130 DOI: 10.2214/ajr.21.25606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rotator cuff tears are the most likely source of shoulder pain in adults and may cause protracted disability. Management of rotator cuff tears is associated with considerable costs. Accurate diagnosis can guide surgical planning and help achieve a favorable clinical outcome. While radiographs remain the initial imaging test for shoulder injury, the roles of MRI and ultrasound (US) as first-line imaging after radiography are evolving. This review leverages current literature and the practical experience of subspecialty musculoskeletal radiologists from different institutions in describing a practical approach to imaging rotator cuff pathology. Both MRI and US are accurate for identifying rotator cuff tears, but each has advantages and shortcomings. As both modalities currently represent reasonable first-line approaches, considerable practice variation has evolved. Given the low cost of US, imagers should strive to optimize the quality of shoulder US examinations and to build referrer confidence in this modality. The roles of direct CT and MR angiography, as well as imaging evaluation of the postoperative rotator cuff, are also considered. Through careful selection among the available imaging modalities, as well as optimal performance and interpretation of such examinations, radiologists can positively contribute to the diagnosis and treatment of patients with rotator cuff injuries.
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16
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Kemp TD, Kaye TR, Scali F. Quadrangular Space Syndrome: A Narrative Overview. J Chiropr Med 2021; 20:16-22. [PMID: 34025301 PMCID: PMC8134859 DOI: 10.1016/j.jcm.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/01/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The purpose of this narrative review of the literature is to provide an overview of quadrangular space syndrome with special attention to its clinical presentation, differential diagnosis, and treatment. METHODS A narrative review of the English-language, peer-reviewed literature was performed using the key words "axillary nerve," "quadrangular space," "quadrilateral space," and "posterior humeral circumflex artery." Databases searched were Medline Complete, Cumulative Index to Nursing and Allied Health Literatures, and Index to Chiropractic Literature. The search period was from 1983 through January 2020. RESULTS There were 85 articles selected for this review. A summary and overview are provided. CONCLUSION Quadrangular space syndrome is an uncommon cause of shoulder pain. Clinicians should consider it as a diagnosis after ruling out more common shoulder conditions and examining other concurrent diseases.
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Affiliation(s)
- Tyler D. Kemp
- College of Chiropractic, Logan University, Ballwin, Missouri
| | - Tyler R. Kaye
- College of Chiropractic, Logan University, Ballwin, Missouri
| | - Frank Scali
- School of Medicine, California University of Science and Medicine, School of Medicine, Colton, California
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17
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Editorial Commentary: There Is Value in Standardizing the Position of the Arm During Magnetic Resonance Imaging Arthrogram of the Shoulder When Evaluating for Suspected Instability (and It Doesn't Have to Be Painful to the Patient!). Arthroscopy 2021; 37:26-27. [PMID: 33384086 DOI: 10.1016/j.arthro.2020.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
Evaluating and treating a shoulder with suspected instability remains a challenge for all. Most authors and surgeons would agree that clinical history and physical examination of the patient are the most important aspects of this evaluation. Over the past 15 years, however, radiographic imaging has become a much more prevalent (and essential) component. Magnetic resonance imaging arthrogram has become the gold standard to evaluate a patient for suspected instability and is currently considered the most appropriate advanced study by the American College of Radiologists to do so in both traumatic and atraumatic presentations.
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Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. J Shoulder Elbow Surg 2020; 29:2213-2220. [PMID: 32650076 DOI: 10.1016/j.jse.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI. The purpose of this study was to assess the ability of 2 new dynamic PE tests to detect supraspinatus pathology in patients for whom traditional static PE tests failed to detect pathology. METHODS We prospectively enrolled 171 patients with suspected rotator cuff pathology with negative findings on traditional rotator cuff PE, who underwent 2 new dynamic PE tests: first, measurement of angle at which the patient first reports pain on unopposed active abduction and, second, the dynamic isotonic manipulation examination (DIME). Patients then underwent shoulder magnetic resonance arthrogram. Data from the new PE maneuvers were compared with outcomes collected from magnetic resonance arthrogram reports. RESULTS Pain during DIME testing had a sensitivity of 96.3% and 92.6% and a negative predictive value of 96.2% and 94.9% in the coronal and scapular planes, respectively. DIME strength ≤86.0 N had a sensitivity of 100% and 96.3% and a negative predictive value of 100% and 95.7% in the coronal and scapular planes, respectively. Pain at ≤90° on unopposed active abduction in the coronal plane had a specificity of 100% and a positive predictive value of 100% for supraspinatus pathology of any kind (ie, tendinopathy, "fraying," or tearing). CONCLUSION DIME is highly sensitive for supraspinatus FTTs in patients with negative traditional rotator cuff PE tests for whom there is still high clinical suspicion of FTTs. Thus, this test is an excellent secondary screening tool for supraspinatus FTTs in patients for whom clinicians suspect rotator cuff pathology despite negative traditional static PE tests. Given its high sensitivity, a negative DIME test rules out supraspinatus FTT well in these patients, and can therefore better inform clinicians which patients should undergo MRI. In addition, the angle at which patients first report pain on unopposed active shoulder abduction is highly specific for supraspinatus pathology.
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Affiliation(s)
- Paul F Abraham
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M Gillinov
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Noah J Quinlan
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
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Abstract
The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.
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20
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Brennan FH, Rao AL, Myers RA, Ferderber M, Marcussen B, Mansfield L, Miller EM, Spittler J, Sylvester J. Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Family Medicine Residency Training. Curr Sports Med Rep 2020; 19:180-188. [DOI: 10.1249/jsr.0000000000000713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Ruling out rotator cuff tear in shoulder radiograph series using deep learning: redefining the role of conventional radiograph. Eur Radiol 2020; 30:2843-2852. [DOI: 10.1007/s00330-019-06639-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
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