1
|
Knight JA, Powell GM, Johnson AC. Radiographic and Advanced Imaging Evaluation of Posterior Shoulder Instability. Curr Rev Musculoskelet Med 2024; 17:144-156. [PMID: 38605219 PMCID: PMC11068713 DOI: 10.1007/s12178-024-09892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Posterior shoulder instability is an uncommon but important cause of shoulder dysfunction and pain which may occur as the result of seizure, high energy trauma, or repetitive stress related to occupational or sport-specific activities. This current review details the imaging approach to the patient with posterior shoulder instability and describes commonly associated soft tissue and bony pathologies identified by radiographs, CT, and MR imaging. RECENT FINDINGS Advances in MR imaging technology and techniques allow for more accurate evaluation of bone and soft tissue pathology associated with posterior shoulder instability while sparing patients exposure to radiation. Imaging can contribute significantly to the clinical management of patients with posterior shoulder instability by demonstrating the extent of associated injuries and identifying predisposing anatomic conditions. Radiologic evaluation should be guided by clinical history and physical examination, beginning with radiographs followed by CT and/or MRI for assessment of osseous and soft tissue pathology. Synthesis of a patient's clinical history, physical exam findings, and radiologic examinations should guide clinical management.
Collapse
Affiliation(s)
- Jennifer A Knight
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Garret M Powell
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
2
|
Billaud A, Garcia-Maya B, Pesquer L, Pillot S. Outcomes After Open Latarjet in Patients With or Without SLAP Lesions. Orthop J Sports Med 2023; 11:23259671231185199. [PMID: 37533499 PMCID: PMC10392464 DOI: 10.1177/23259671231185199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 08/04/2023] Open
Abstract
Background Up to 20% of shoulders with anterior instability are associated with superior labrum anterior-posterior (SLAP) lesions, and they remain untreated after an open Latarjet procedure. SLAP lesions can be responsible for pain and feelings of instability in high-demand patients. Purpose/Hypothesis The aim of this study was to compare the early functional outcomes and return to sport rates in athletes after the Latarjet procedure with versus without associated SLAP lesions. It was hypothesized that untreated SLAP lesions would not influence clinical results. Study Design Cohort study; Level of evidence, 3. Methods Inclusion criteria were athletes with anterior shoulder instability treated with Latarjet procedure, a minimum follow-up of 1 year, and an available preoperative computed tomography arthrogram. We recorded patient characteristics; type of sport; bone loss; Rowe, Single Assessment Numeric Evaluation (SANE), and 11-item Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; 5-point pain and satisfaction scores; reported apprehension; and return to sport. Patients with and without a preoperative type 5 SLAP lesion on imaging were compared. Results Fifty patients were included (mean age, 22 ± 5 years [range, 16-36 years]; mean follow-up, 27 ± 9 months [range, 12-42 months]). Thirty-four patients practiced contact sports, including 20 rugby players. Twelve patients (24%) had a preoperative SLAP lesion. Groups with (+) and without (-) a SLAP lesion were comparable in terms of age, sex, number of instability episodes, type of sport, and glenoid and humeral bone loss. The SLAP+ group had significantly worse outcomes with a lower Rowe score (79 ± 23 vs 91 ± 15; P = .018) and painless rate (50% vs 77%; P = .04). There were no significant differences between the groups in SANE score (SLAP+ vs SLAP-: 80% vs 87%), QuickDASH score (8% vs 8%), return to sport (83% vs 91%), apprehension (79% vs 50%), and reported satisfaction. There was 1 episode of postoperative subluxation in each group. Conclusion Patients who underwent an open Latarjet procedure with an associated SLAP tear more frequently reported postoperative pain than those without a SLAP lesion. Patients with untreated SLAP tears had significantly lower Rowe scores, although SANE score and return to sport were not significantly different between the groups.
Collapse
|
3
|
Nicholas Nacey, Fox MG, Blankenbaker DG, Chen D, Frick MA, Jawetz ST, Mathiasen RE, Raizman NM, Rajkotia KH, Said N, Stensby JD, Subhas N, Surasi DS, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023; 20:S49-S69. [PMID: 37236752 DOI: 10.1016/j.jacr.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | | | | | - Ross E Mathiasen
- University of Nebraska Medical Center, Omaha, Nebraska; American College of Emergency Physicians
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; American Academy of Orthopaedic Surgeons
| | - Kavita H Rajkotia
- University of Michigan Health System, Ann Arbor, Michigan; Committee on Emergency Radiology-GSER
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
| |
Collapse
|
4
|
Can We Apply Snyder's Arthroscopic Classification to Ultrasound for Evaluating Rotator Cuff Tears? A Comparative Study with MR Arthrography. Diagnostics (Basel) 2023; 13:diagnostics13030483. [PMID: 36766588 PMCID: PMC9914918 DOI: 10.3390/diagnostics13030483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
We aimed to demonstrate the applicability of Snyder's arthroscopic classification of rotator cuff tears (RCT) in shoulder ultrasound (US) and to compare it with MR arthrography (MRA). Forty-six patients (34 males; mean age:34 ± 14 years) underwent shoulder US and MRA. Two radiologists (R1 = 25 years of experience; R2 = 2 years of experience) assigned A1-4, B1-4, or C1-4 values depending on the extent of RCT in both US and MRA. Inter-reader intra-modality and intra-reader inter-modality agreement were calculated using Cohen's kappa coefficient. US sensitivity and specificity of both readers were calculated using MRA as the gold standard. Patients were divided into intact cuff vs. tears, mild (A1/B1) vs. moderate (A2-3/B2-3) tears, mild-moderate (A2/B2) vs. high-moderate (A3/B3) cuff tears, moderate (A2-3/B2-3) vs. advanced (A4/B4) and full-thickness (C) tears. The highest agreement values in inter-reader US evaluation were observed for mild-moderate vs. high-moderate RCT (K = 0.745), in inter-reader MRA evaluation for mild vs. moderate RCT (K = 0.821), in R1 inter-modality (US-MRA) for mild-moderate vs. high-moderate and moderate vs. advanced/full-thickness RCT (K = 1.000), in R2 inter-modality (US-MRA) for moderate vs. advanced/full-thickness RCT (K = 1.000). US sensitivity ranged from 88.89%(R1)-84.62%(R2) to 100% (both readers), while specificity from 77.78%(R1)-90.00%(R2) to 100% (both readers). Snyder's classification can be used in US to ensure the correct detection and characterization of RCT.
Collapse
|
5
|
Cheraya G, Sharma S, Chhabra A. Dual energy CT in musculoskeletal applications beyond crystal imaging: bone marrow maps and metal artifact reduction. Skeletal Radiol 2022; 51:1521-1534. [PMID: 35112139 DOI: 10.1007/s00256-021-03979-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
Dual energy CT (DECT) is becoming increasingly popular and valuable in the domain of musculoskeletal imaging. Gout maps and crystal detection have been predominant indications for about a decade. Other important indications of bone marrow maps and metal artifact reduction are also frequent with added advantages of detection and characterization of bone marrow lesions similar to MR imaging and diagnosis of hardware related complications, respectively. This article discusses technical considerations and physics of DECT imaging and its role in musculoskeletal indications apart from crystal imaging with respective case examples and review of the related literature. DECT pitfalls in these domains are also highlighted and the reader can gain knowledge of above concepts for prudent use of DECT in their musculoskeletal and general practices.
Collapse
Affiliation(s)
| | - Salil Sharma
- Mary Imogene Bassett Hospital, Cooperstown, NY, USA
| | | |
Collapse
|
6
|
Peebles LA, Golijanin P, Peebles AM, Douglass BW, Arner JW, Provencher MT. Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis. Am J Sports Med 2022; 50:2469-2475. [PMID: 35666123 DOI: 10.1177/03635465221101016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the glenoid track concept presents a useful prediction for recurrent glenohumeral instability, little is known about the humeral head bony architecture as it relates to glenoid erosion in the setting of bipolar bone loss. PURPOSE To (1) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSLs) in a cohort of patients with anterior instability using 3-dimensional imaging software and (2) assess the relationships between GBL and HSL characteristics. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients were identified who had anterior shoulder instability with a minimum 5% GBL and evidence of HSL confirmed on computed tomography. Unilateral 3-dimensional models of the ipsilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using MIMICS software (Materialise NV). GBL surface area, width, defect length, and glenoid track width were quantified. The volume, surface area, width, and depth of identified HSLs were quantified with their location (medial, superior, and inferior extent) on the humeral head. Severity of GBL was defined as percentage glenoid bone surface area loss and categorized as low grade (5%-10%), moderate grade (>10% to 20%), high grade (>20% to 30%), and extensive (>30%). Analysis of variance was then computed to determine significance (P < .05) between severity of GBL and associated HSL parameters. RESULTS In total, 100 patients met inclusion criteria (mean age, 27.9 years; range, 18-43 years), which included 58 right shoulders and 42 left shoulders (84 male, 16 female). Among groups, there were 32 patients with low-grade GBL (mean GBL = 6.1%), 38 with moderate grade (mean GBL = 16.2%), 17 with high grade (mean GBL = 23.7%), and 13 with extensive (mean GBL = 34.0%), with an overall mean GBL of 18.1% (range, 5%-39%). Patients with 5%-10% GBL had significantly narrower HSLs (average and maximum width; P < .03) and deeper HSLs (average depth; P = .002) as compared with all other GBL groups, while greater GBL was associated with wider and shallower HSLs. GBL width, percentage width loss, defect length, and glenoid track width all significantly differed across the 4 GBL groups (P < .05). CONCLUSION HSLs had significantly different morphological characteristics depending on the severity of GBL, indicating that GBL was directly related to the characteristics of HSLs. Patients presenting with smaller glenoid defects had significantly narrower and deeper HSLs with less humeral head surface area loss, while greater GBL was associated with wider and shallower HSLs.
Collapse
Affiliation(s)
- Liam A Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Petar Golijanin
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | | | | | - Justin W Arner
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
7
|
A Comparative Study on the Diagnostic Value of CTA and MRA in Anterior Dislocation of Shoulder. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9461236. [PMID: 35450205 PMCID: PMC9017485 DOI: 10.1155/2022/9461236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Objective To investigate the diagnostic value of CTA and MRA in anterior dislocation of shoulder. Methods The detection of inferior glenohumeral ligament injuries, anterior inferior labrum injuries, and bone and cartilage injuries by the two examination procedures was observed and compared with the results of arthroscopy or surgery on patients referred to our hospital owing to anterior dislocation of shoulder. Results. A total of 36 patients with shoulder injuries were gathered for this study. 32 cases with anterior inferior labrum tearings (27 cases detected by CTA and 30 cases by MRA), 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA), 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA), and 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA) were detected. There were 30 bone and cartilage injuries, including 18 fractures (CTA identified 18), 10 bone contusions (CTA detected 0), and 5 cartilage damage (CTA detected 0) (CTA detected 0, MRA detected 5). Conclusion The detection rate of MRA is better than that of CTA for inferior glenohumeral ligament injuries. For anterior inferior labrum injury, the detection rate of CTA and MRA was similar. CTA is more conducive to the detection of fracture blocks, while MRA is more advantageous for the observation of bone contusion and cartilage damage.
Collapse
|
8
|
Choi YS, Choo HJ, Lee SJ, Kim DW, Han JY, Kim DS. Computed tomography arthrography of the shoulder with tin filter-based spectral shaping at 100 kV and 140 kV. Acta Radiol 2021; 62:1349-1357. [PMID: 33070634 DOI: 10.1177/0284185120965551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tin filter-based spectral shaping has been used for low-dose and ultra-low-dose computed tomography (CT) in several body parts. However, studies of shoulder CT arthrography with spectral shaping are limited. PURPOSE To investigate image quality and radiation dose of shoulder CT arthrography with tin filter-based spectral shaping at 100 kV (Sn 100 kV) and 140 kV (Sn 140 kV) in comparison with the conventional protocol. MATERIAL AND METHODS Ninety-nine shoulder CT arthrographies with protocols of Sn 100 kV (n = 32), Sn 140 kV (n = 25), and conventional 120 kV (n = 42) were retrospectively evaluated. Qualitative image quality, CT attenuations of intra-articular contrast mixture and tissues, background noise, contrast-to-noise ratios (CNRs), and figures of merit were assessed. Radiation doses were compared. RESULTS CT arthrographies with Sn 100 kV and Sn 140 kV yielded approximately 70% and 60% radiation dose reduction, respectively, compared with the conventional 120 kV (P < 0.001). Qualitative image noise and quantitative background noise of Sn 100 kV and Sn 140 kV were significantly less than those of the conventional protocol. Qualitative image contrast, CT attenuations of intra-articular contrast mixture and tissues, and CNRs for Sn 100 were similar to those of the conventional 120 kV. However, Sn 140 kV showed significantly lower qualitative contrast and CNRs than 120 kV. Sn 100 kV was the most dose efficient among the three protocols. CONCLUSION Shoulder CT arthrography with Sn 100 kV substantially reduced radiation dose and image noise and maintained image contrast, compared with the conventional protocol.
Collapse
Affiliation(s)
- Yun Seok Choi
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hye Jung Choo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sun Joo Lee
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Dong Wook Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Ji-yeon Han
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Da Som Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| |
Collapse
|
9
|
Morsy MG, Waly AHT, Galal MA, Ayman EHM, Gawish HM. Glenoid labrum articular disruption in a six-year-old child: A case report. Trauma Case Rep 2021; 35:100527. [PMID: 34504936 PMCID: PMC8414079 DOI: 10.1016/j.tcr.2021.100527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Traumatic anterior shoulder instability is a rare occurrence in the childhood. While glenoid labrum articular disruption itself is an uncommon condition that accompanies shoulder instability in the contact athletes, the occurrence of such lesion in a child is of extreme rarity. To the best of our knowledge, this case is the first to be reported at such a young age. Case presentation A six-year-old female child is presented to the clinic with a painful left shoulder and limited range of motion after a fall which was abruptly prevented by the father; hence, the child was grabbed by the arm, leaving the body to pivot around the shoulder at full force in an abduction external rotation position. Radiological studies revealed anteroinferior osteochondral fragment and a matching glenoid defect. Open surgery was performed, and the osteochondral fragment with the attached labrum was fixed using smooth K-wires. Conclusions Although rare, shear fractures of the anterior glenoid associated with chondral damage are possible in early childhood. However, it demands a forceful burst of abduction external rotation force which could have been avoided if the child was left to fall. The use of two K-wires via an open deltopectoral approach achieved excellent results with minimum cartilage damage.
Collapse
Affiliation(s)
- Mohamed Gamal Morsy
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
- Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, Egypt
- Corresponding author at: Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Egypt.
| | - Ahmed Hassan Taha Waly
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
- Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, Egypt
| | - Mostafa Ashraf Galal
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
- Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, Egypt
| | - El Hussein Mohamed Ayman
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
- Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, Egypt
| | - Hesham Mohamed Gawish
- Department of Orthopedic Surgery and Traumatology, Kafr el-sheikh University, Egypt
- Faculty of Medicine, Kafr el-sheikh University, Sakha Road, Kafr Elsheikh, Egypt
| |
Collapse
|
10
|
High resolution flat-panel CT arthrography vs. MR arthrography of artificially created osteochondral defects in ex vivo upper ankle joints. PLoS One 2021; 16:e0255616. [PMID: 34375344 PMCID: PMC8354460 DOI: 10.1371/journal.pone.0255616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE High resolution flat-panel computed tomography arthrography (FPCT-A) and magnetic resonance arthrography (MR-A) are well suited to evaluate osteochondral lesions. The current study compares the performance of FPCT-A versus MR-A in an experimental setting. METHODS Fourteen cadaveric ankles were prepared with artificial osteochondral defects of various sizes in four separate talar locations. After intra-articular contrast injection, FPCT-A and 3-T MR-A were acquired. Each defect was then filled with synthetic pallets. The resulting cast was used as reference. Two independent radiologists measured the dimensions of all defects with FPCT-A and MR-A. Intra-class correlation coefficients (ICC) were calculated. Data were compared using t-tests and Bland-Altman plots. RESULTS The correlation for FPCT-A and cast was higher compared to MR-A and cast (ICC 0.876 vs. 0.799 for surface [length x width]; ICC 0.887 vs. 0.866 for depth, p<0.001). Mean differences between FPCT-A and cast measurements were -1.1 mm for length (p<0.001), -0.7 mm for width (p<0.001) and -0.4 mm for depth (p = 0.023). By MR-A, there were no significant differences for length and width compared to cast (p>0.05). Depth measurements were significantly smaller by MR-A (mean difference -1.1 mm, p<0.001). There was no bias between the different modalities. CONCLUSIONS Ex vivo FPCT-A and MR-A both deliver high diagnostic accuracy for the evaluation of osteochondral defects. FPCT-A was slightly more accurate than MR-A, which was most significant when measuring lesion depth.
Collapse
|
11
|
Sandhu R, Aslan M, Obuchowski N, Primak A, Karim W, Subhas N. Dual-energy CT arthrography: a feasibility study. Skeletal Radiol 2021; 50:693-703. [PMID: 32948903 DOI: 10.1007/s00256-020-03603-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the feasibility of producing 2-dimensional (2D) virtual noncontrast images and 3-dimensional (3D) bone models from dual-energy computed tomography (DECT) arthrograms and to determine whether this is best accomplished using 190 keV virtual monoenergetic images (VMI) or virtual unenhanced (VUE) images. MATERIALS AND METHODS VMI and VUE images were retrospectively reconstructed from patients with internal derangement of the shoulder or knee joint who underwent DECT arthrography between September 2017 and August 2019. A region of interest was placed in the area of brightest contrast, and the mean attenuation (in Hounsfield units [HUs]) was recorded. Two blinded musculoskeletal radiologists qualitatively graded the 2D images and 3D models using scores ranging from 0 to 3 (0 considered optimal). RESULTS Twenty-six patients (mean age ± SD, 57.5 ± 16.8 years; 6 women) were included in the study. The contrast attenuation on VUE images (overall mean ± SD, 10.5 ± 16.4 HU; knee, 19.3 ± 10.7 HU; shoulder, 5.0 ± 17.2 HU) was significantly lower (p < 0.001 for all comparisons) than on VMI (overall mean ± SD, 107.7 ± 43.8 HU; knee, 104.6 ± 31.1 HU; shoulder, 109.6 ± 51.0 HU). The proportion of cases with optimal scores (0 or 1) was significantly higher with VUE than with VMI for both 2D and 3D images (p < 0.001). CONCLUSIONS DECT arthrography can be used to produce 2D virtual noncontrast images and to generate 3D bone models. The VUE technique is superior to VMI in producing virtual noncontrast images.
Collapse
Affiliation(s)
- Rashpal Sandhu
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Mercan Aslan
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Andrew Primak
- Siemens Medical Solutions USA, Inc., Malvern, PA, 19355, USA
| | - Wadih Karim
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Naveen Subhas
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| |
Collapse
|
12
|
Pagliano S, Chemouni D, Guggenberger R, Pauly V, Guenoun D, Champsaur P, Le Corroller T. Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo. Skeletal Radiol 2020; 49:1259-1265. [PMID: 32146486 DOI: 10.1007/s00256-020-03398-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the diagnostic performance of flat-panel computed tomography (FPCT) arthrography for cartilage defect detection in the ankle joint to direct magnetic resonance (MR) arthrography using multidetector computed tomography (MDCT) arthrography as the reference standard. METHODS Twenty-seven patients with specific suspicion of articular cartilage lesion underwent ankle arthrography with injection of a mixture of diluted gadolinium and iobitridol and were examined consecutively with the use of FPCT, MDCT, and 1.5 T MR imaging. FPCT, MDCT, and MR arthrography examinations were blinded and randomly evaluated by two musculoskeletal radiologists in consensus. In each ankle, eight articular cartilage areas were assessed separately: medial talar surface, medial talar trochlea, lateral talar trochlea, lateral talar surface, tibial malleolus, medial tibial plafond, lateral tibial plafond, and fibular malleolus. Findings at FPCT and MR were compared with MDCT assessments in 216 cartilage areas. RESULTS For the detection of cartilage defects, FPCT demonstrated a sensitivity of 97%, specificity of 95%, and accuracy of 96%; and MR arthrography showed a sensitivity of 69%, specificity of 94%, and accuracy of 87%. FPCT and MR arthrography presented almost perfect agreement (κ = 0.87) and moderate agreement (κ = 0.60), respectively, with MDCT arthrography. Mean diagnostic confidence was higher for FPCT (2.9/3) than for MR (2.3/3) and MDCT (2.7/3) arthrography. CONCLUSIONS FPCT demonstrated better accuracy than did 1.5 T MR arthrography for cartilage defect detection in the ankle joint. Therefore, FPCT should be considered in patients scheduled for dedicated imaging of ankle articular cartilage.
Collapse
Affiliation(s)
- Sarah Pagliano
- Radiology Department, APHM, Marseille, France.,CNRS, ISM UMR 7287, Aix-Marseille Université, Marseille, France
| | | | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Vanessa Pauly
- Unité de Recherche EA3279, Santé Publique et Maladies Chroniques: Qualité de vie Concepts, Usages et Limites, Déterminants, Aix-Marseille Université, Marseille, France
| | - Daphné Guenoun
- Radiology Department, APHM, Marseille, France.,CNRS, ISM UMR 7287, Aix-Marseille Université, Marseille, France
| | - Pierre Champsaur
- Radiology Department, APHM, Marseille, France.,CNRS, ISM UMR 7287, Aix-Marseille Université, Marseille, France
| | - Thomas Le Corroller
- Radiology Department, APHM, Marseille, France. .,CNRS, ISM UMR 7287, Aix-Marseille Université, Marseille, France.
| |
Collapse
|
13
|
Kouzelis A, Kokkalis ZT, Lachanas I, Matzaroglou C, Solomou A, Panagopoulos A. Arthroscopic Treatment of Luxatio Erecta Humeri Associated with Greater Tuberosity Fracture, Bankart Lesion, and Partial Rotator Cuff Tear: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923727. [PMID: 32555129 PMCID: PMC7322212 DOI: 10.12659/ajcr.923727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/13/2020] [Accepted: 04/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Luxatio erecta humeri (LEH) is a rare injury present in only 0.5% of shoulder dislocations. Much of the relevant literature is focused on the initial management and proper reduction techniques, although the prevalence of associated injuries can reach 80%. A case of LEH associated with greater tuberosity (GT) fracture and rotator cuff (RC) tear in a young laborer managed with closed reduction and arthroscopic repair of the labrum and rotator cuff is presented. CASE REPORT A 28-year-old man presented to our hospital with severe pain in his right shoulder after a high-impact motor vehicle accident. Standard anteroposterior radiographs revealed an inferior dislocation (LEH) of the right shoulder and a fracture of the GT. The patient was initially managed with closed reduction under mild intravenous sedation, using a 2-step maneuver followed by arthroscopic evaluation of the joint the next day. During arthroscopic evaluation, an anterior-inferior Bankart lesion, impaction of the humeral head with a minimal displaced GT fracture, and a partial RC tear were identified and successfully treated arthroscopically. The patient had immobilization in a simple sling for 6 weeks and he followed a standard 3-month physiotherapy protocol for rotator cuff, finally regaining almost normal range of shoulder motion at 1 year. CONCLUSIONS Although very good results of non-operative treatment of LEH have been reported in the literature, the co-existence of intra-articular lesions such as labral and rotator cuff tears makes arthroscopic repair an attractive alternative in individual cases.
Collapse
Affiliation(s)
- Antonis Kouzelis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Zinon T. Kokkalis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Ioannis Lachanas
- Department of Orthopaedics, General Army Hospital of Athens, Athens, Greece
| | | | | | - Andreas Panagopoulos
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| |
Collapse
|
14
|
Abstract
Most first-time anterior glenohumeral dislocations occur as the result of trauma. Many patients suffer recurrent episodes of anterior shoulder instability (ASI). The anatomy and biomechanics of ASI is addressed, as is the pathophysiology of capsulolabral injury. The roles of imaging modalities are described, including computed tomography (CT) and MR imaging with the additional value of arthrography and specialized imaging positions. Advances in 3D CT and MR imaging particularly with respect to the quantification of humeral and glenoid bone loss is discussed. The concepts of engaging and nonengaging lesions as well as on-track and off-track lesions are examined.
Collapse
Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA.
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA
| | | |
Collapse
|
15
|
Liu F, Cheng X, Dong J, Zhou D, Han S, Yang Y. Comparison of MRI and MRA for the diagnosis of rotator cuff tears: A meta-analysis. Medicine (Baltimore) 2020; 99:e19579. [PMID: 32195972 PMCID: PMC7220562 DOI: 10.1097/md.0000000000019579] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. METHODS PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. RESULTS Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. CONCLUSION MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.
Collapse
Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Shumei Han
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| |
Collapse
|
16
|
Lemme NJ, Kuczmarski AS, Goodman AD, Ready LV, Dickens JF, Owens BD. Management and Outcomes of In-Season Anterior Shoulder Instability in Athletes. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.19.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
17
|
Liu F, Cheng X, Dong J, Zhou D, Sun Q, Bai X, Wang D. Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:487. [PMID: 31656171 PMCID: PMC6815459 DOI: 10.1186/s12891-019-2876-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. METHODS Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. CONCLUSION MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.
Collapse
Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qian Sun
- Department of General and Paediatric Surgery, Yantai Yuhuangding Hospital affiliated Qingdao University, Yuhuangding eastern road 20, Yantai, China
| | - Xiaohui Bai
- Department of Clinical Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road 324, Jinan, 250021, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| |
Collapse
|
18
|
Foti G, Mantovani W, Catania M, Avanzi P, Caia S, Zorzi C, Carbognin G. Evaluation of glenoid labral tears: comparison between dual-energy CT arthrography and MR arthrography of the shoulder. Radiol Med 2019; 125:39-47. [PMID: 31541346 DOI: 10.1007/s11547-019-01083-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of dual-energy computed tomography arthrography (DE-CTA) and magnetic resonance arthrography (MRA) of the shoulder in depicting glenoid labral tears. METHODS This prospective institutional review board-approved study included 47 consecutive patients (28 males, 19 females; mean age of 34.2 years) studied between January 2017 and October 2018. All patients underwent DE-CTA and MRA the same day. Two radiologists (25 and 11 years of experience, respectively), blinded to clinical data, evaluated the presence labral tears on virtual-blended 120 kV standard CTA and on DE-CTA images. A third radiologist (18 years of experience) evaluated the MRA images. Diagnostic accuracy values were calculated by using surgery as standard of reference. Inter-observer and intra-observer agreements were calculated with k statistics. A value of p < 0.05 was considered statistically significant. RESULTS Surgery revealed the presence of labral tears in 38/47 patients (80.9%). Sensitivity and specificity values in diagnosing labral tears were 84.2% and 77.8% for MRA (Reader 3), 84.2% and 77.8% for CTA (Reader 1), 84.2% and 88.9% for CTA (Reader 2), 89.5% and 88.9% for DE-CTA (Reader 1), and 92.1% and 88.9% for DE-CTA (Reader 2). A nonsignificant increase in AUC values with respect to MRA was obtained by reading the CTA (p = 0.470) and DE-CTA dataset (p = 0.217), respectively. Inter-observer agreements were near perfect for CTA (k = 0.84) and substantial for DE-CTA reading (k = 0.76). Intra-observer agreements were near perfect both for CTA (k = 0.88) and for DE-CTA reading (k = 0.82). CONCLUSION DE-CTA and MRA were not different in terms of diagnostic performance.
Collapse
Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Negrar, Italy.
| | - William Mantovani
- Department of Preventive Medicine Public Health Trust, Trento, Italy
| | - Matteo Catania
- Department of Radiology, IRCCS Sacro Cuore Hospital, Negrar, Italy
| | - Paolo Avanzi
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Simone Caia
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Claudio Zorzi
- Department of Orthopaedic Surgery, Sacro Cuore Hospital, Negrar, Italy
| | | |
Collapse
|
19
|
Preoperative imaging of traumatic anterior shoulder instability: Diagnostic effectiveness of magnetic resonance arthrography and comparison with conventional magnetic resonance imaging and arthroscopy. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Aguet J, Becce F, Dunet V, Vlassenbroek A, Coche EE, Omoumi P. Optimizing radiation dose parameters in MDCT arthrography of the shoulder: illustration of basic concepts in a cadaveric study. Skeletal Radiol 2019; 48:1261-1268. [PMID: 30725159 DOI: 10.1007/s00256-019-3150-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine in a cadaveric study the lowest achievable radiation dose and optimal tube potential generating diagnostic image quality in multidetector computed tomography (MDCT) arthrography of the shoulder. MATERIALS AND METHODS Six shoulders from three human cadavers were scanned using a 256-MDCT system after intra-articular injection of diluted iodinated contrast material. Using six decreasing radiation dose levels (CTDIvol: 20, 15, 10, 8, 6, and 4 mGy) and for each dose level, four decreasing tube potentials (140, 120, 100, and 80 kVp), image noise and contrast-to-noise ratio (CNR) were measured. Two independent and blinded observers assessed the overall diagnostic image quality, subjective amount of noise, and severity of artifacts according to a four-point scale. Influence of those MDCT data acquisition parameters on objective and subjective image quality was analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests, and pairwise comparisons were performed. RESULTS Multidetector CT protocols with radiation doses of 15 mGy or higher, combined with tube potentials of 100 kVp or higher, were equivalent in CNR to the reference 20 mGy-140 kVp protocol (all p ≥ 0.054). Above a CTDIvol of 10 mGy and a tube potential of 120 kVp, all protocols generated diagnostic image quality and subjective noise equivalent to the 20 mGy-140 kVp protocol (all p ≥ 0.22). CONCLUSIONS Diagnostic image quality in MDCT arthrography of the shoulder can be obtained with a radiation dose of 10 mGy at an optimal tube potential of 120 kVp, corresponding to a reduction of up to 50% compared with standard-dose protocols, and as high as 500% compared with reported protocols in the literature.
Collapse
Affiliation(s)
- Julien Aguet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | | | - Emmanuel E Coche
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| |
Collapse
|
21
|
Pan Z, Huang F, Li J, Tang X. [Current concepts of diagnostic techniques and measurement methods for bone defect in patient with anterior shoulder instability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:762-767. [PMID: 31198007 DOI: 10.7507/1002-1892.201812078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the diagnosis and measurement methods of bone defect in anterior shoulder instability (glenoid bone defect and Hill-Sachs lesion). Methods The related literature on the diagnosis and measurement of the bone defect in anterior shoulder instability was reviewed and summarized. Results The commonly used techniques for the diagnosis of anterior glenoid bone defect and Hill-Sachs lesion of humeral head include X-ray, CT, MRI, arthroscopy, arthrography. The methods for measuring the degree of anterior glenoid bone defect include Griffith method, glenoid index method, Pico method, and best-fit circle method. The indexes for measuring the Hill-Sachs lesion include the length, width, depth, and volume. X-ray is mainly used for primary screening. Best-fit circle method on three-dimensional (3D) CT reconstruction is commonly used to measure the glenoid bone defect currently. Glenoid track theory on 3D CT reconstruction is popular in recent years. Reliability of measuring the glenoid bone defect and Hill-Sachs lesion with MRI and arthroscopy is still debatable. Arthrography is more and more used in the diagnosis of shoulder joint instability of bone defect and concomitant soft tissue injury. Conclusion How to improve the accuracy of evaluating glenoid bone defect and Hill-Sachs lesion before surgery still need further study.
Collapse
Affiliation(s)
- Zhengfeng Pan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Tang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| |
Collapse
|
22
|
Small KM, Adler RS, Shah SH, Roberts CC, Bencardino JT, Appel M, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Subhas N, Thiele R, Towers JD, Tynus KM, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Atraumatic. J Am Coll Radiol 2019; 15:S388-S402. [PMID: 30392607 DOI: 10.1016/j.jacr.2018.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/25/2023]
Abstract
Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | | | - Shaan H Shah
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | | | - Darlene F Metter
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York; American College of Rheumatology
| | - Jeffrey D Towers
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | |
Collapse
|
23
|
Amini B, Beckmann NM, Beaman FD, Wessell DE, Bernard SA, Cassidy RC, Czuczman GJ, Demertzis JL, Greenspan BS, Khurana B, Lee KS, Lenchik L, Motamedi K, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Traumatic. J Am Coll Radiol 2019; 15:S171-S188. [PMID: 29724420 DOI: 10.1016/j.jacr.2018.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/08/2023]
Abstract
Traumatic shoulder pain is pain directly attributed to a traumatic event, either acute or chronic. This pain may be the result of either fracture (the clavicle, scapula, or proximal humerus) or soft-tissue injury (most commonly of the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Imaging assessment of traumatic shoulder pain begins with conventional radiography and, depending on physical examination findings, will require MRI or MR arthrography for assessment of soft-tissue injuries and CT for delineation of fracture planes. Ultrasound excels in assessment of rotator cuff injuries but has limited usefulness for assessment of the deep soft-tissues. CT angiography and conventional arteriography are helpful for assessment of vascular injury, and bone scintigraphy can be used in assessment of complex regional pain syndrome after traumatic shoulder injury. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Behrang Amini
- Principal Author, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | | | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | | | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | |
Collapse
|
24
|
High-resolution flat panel CT versus 3-T MR arthrography of the wrist: initial results in vivo. Eur Radiol 2018; 29:3233-3240. [PMID: 30552480 DOI: 10.1007/s00330-018-5901-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to compare the diagnostic performance of direct C-arm flat panel computed tomography arthrography (FPCT-A) with direct magnetic resonance arthrography (MR-A) of the wrist in patients with clinically suspected pathologies. METHODS Forty-nine patients underwent tri-compartmental wrist arthrography. FPCT-A was acquired using a high-resolution acquisition mode, followed by a 3-T MR exam using a dedicated wrist coil. Image quality and artifacts of FPCT-A and MR-A were evaluated with regard to the depictability of anatomical structures. The time stamps for the different image acquisitions were recorded for workflow assessment. RESULTS Image quality was rated significantly superior for all structures for FPCT-A (p < 0.001) as compared to MR-A including intrinsic ligaments, TFCC, cartilage, subchondral bone, and trabeculae. The differences in image quality were highest for cartilage (2.0) and lowest for TFCC (0.9). The artifacts were rated lower in MR-A than in FPCT-A (p < 0.001). The procedure was more time-efficient in FPCT-A than in MR-A. CONCLUSIONS FPCT-A of the wrist provides superior image quality and optimized workflow as compared to MR-A. Therefore, FPCT-A should be considered in patients scheduled for dedicated imaging of the intrinsic structures of the wrist. KEY POINTS • FPCT arthrography allows high-resolution imaging of the intrinsic wrist structures. • The image quality is superior as compared to MR arthrography. • The procedure is more time-efficient than MR arthrography.
Collapse
|
25
|
Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. Biomechanics of posterior shoulder instability - current knowledge and literature review. World J Orthop 2018; 9:245-254. [PMID: 30479971 PMCID: PMC6242730 DOI: 10.5312/wjo.v9.i11.245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/31/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year, even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare, biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search, including PubMed and Medline, and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The PubMed/Medline databases were utilized, and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology, biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner, which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabilization of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability, with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.
Collapse
Affiliation(s)
- Henrik Constantin Bäcker
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
| | - Samuel E Galle
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
| | - Mauro Maniglio
- Department of Orthopedics, HFR Cantonal Hospital of Fribourg, Fribourg 1752, Switzerland
| | - Melvin Paul Rosenwasser
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
| |
Collapse
|
26
|
Magee T. Imaging of the post-operative shoulder: does injection of iodinated contrast in addition to MR contrast during arthrography improve diagnostic accuracy and patient throughput? Skeletal Radiol 2018; 47:1253-1261. [PMID: 29549380 DOI: 10.1007/s00256-018-2927-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Post-operative shoulder patients are often difficult to image due to scar tissue, metallic artifact, and residual irregularity of anatomic structures. The purpose of this study was to assess MR versus MR arthrography versus CT arthrography in the post-operative shoulder. Also, we assessed whether injecting CT contrast in addition to MR contrast during arthrography improved patient care. METHODS AND MATERIALS One hundred consecutive post-operative conventional shoulder MR and MR arthrography exams performed on the same patients were reviewed retrospectively by two musculoskeletal radiologists. A combination of gadolinium and CT contrast was injected at arthrography so CT imaging could be performed post arthrography if metallic artifact precluded MR imaging. Twenty-two of these patients also had CT exams performed post-arthrography due to metallic artifact on MR exam. Exams were assessed for labral tears and supraspinatus tendon tears. All patients went on to arthroscopy. RESULTS Of these 100 patients, 35 had SLAP (superior labral anterior to posterior) tears, 22 had posterior labral tears, 24 had anterior labral tears, and 46 had full-thickness supraspinatus tendon tears on conventional MR exam. On MR arthrography, 48 patients had SLAP tears, 26 had posterior labral tears, 27 had anterior labral tears, and 54 had full-thickness supraspinatus tendon tears. MR arthrogram detected 12 SLAP tears, three posterior labral tears, three anterior labral tears, and nine supraspinatus tendon tears not detected on conventional MR exam. Twenty-two patients had additional imaging performed with CT arthrography due to metallic artifacts precluding MR assessment of shoulder pathology. There were four SLAP tears, six posterior labral tears, five anterior labral tears, and five supraspinatus tendon tear seen on CT arthrography not seen on MR exam. CONCLUSIONS MR arthrography is more accurate than conventional MR in assessment of post-operative shoulder pathology. CT arthrography can detect additional pathology when there is metallic artifact in post-operative patients. It is beneficial to inject a combination of gadolinium and CT contrast at arthrography so CT imaging can be performed post-arthrography if metallic artifact precludes imaging shoulder pathology by MR.
Collapse
Affiliation(s)
- Thomas Magee
- NSI, 255 North Sykes Creek Parkway, Merritt Island, FL, 33573, USA. .,University of Central Florida School of Medicine, 6850 Lake Nona Blvd., Orlando, FL, 32827, USA.
| |
Collapse
|
27
|
van der Linde JA, Wessel RN, Trantalis JN, van den Bekerom MPJ. Review of Latarjet (1954) on the treatment of recurrent shoulder dislocations. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This classic discusses the original publication ‘Treatment of recurrent dislocation of the shoulder’ on the Latarjet procedure. This surgical technique that has become one of the basics in shoulder-stabilising surgery, introduced by Latarjet in 1954 in the journal Lyon Chirurgical. Inspired by publications of colleagues in the field of shoulder surgery, Latarjet introduced a technique that transfers the coracoid process to the anterior glenoid rim in patients with anterior shoulder instability. Although being outrun in popularity by the Bankart repair for several decades, improved knowledge regarding long-term outcomes, surgical techniques and patient characteristics such as bone loss and participation in contact sports has led to renewed interest in the Latarjet procedure. This especially accounts for patients with significant glenohumeral bone loss or patients with a previously failed soft tissue repairs. Whereas the increase in popularity has led to many studies focussing on various aspects, the 15 basics of the initial procedure have virtually remained unchanged.
Collapse
|
28
|
De Coninck T, Ngai SS, Tafur M, Chung CB. Imaging the Glenoid Labrum and Labral Tears. Radiographics 2017; 36:1628-1647. [PMID: 27726737 DOI: 10.1148/rg.2016160020] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The shoulder joint is the most unstable articulation in the entire human body. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. Broadly, clinical unidirectional instability can be subdivided into anterior and posterior instability, which usually raise concern for anteroinferior and posteroinferior labral lesions, respectively. In the special case of superior labral damage, potential dislocation is blocked by structures that include the acromion; hence, while damage elsewhere commonly manifests as clinical instability, damage to the superior labrum is often described by the term microinstability. In this particular case, one of the radiologist's main concerns should be classic superior labral anteroposterior lesions. The glenoid labrum is also subject to a wide range of normal variants that can mimic labral tears. Knowledge of these variants is central to interpreting an imaging study of the labrum because misdiagnosis of labral variants as tears can lead to superfluous surgical procedures and decreased shoulder mobility. This article reviews labral anatomy and normal labral variants, describes their imaging features, and discusses how to discriminate normal variants from labral tears. Specific labral pathologic lesions are described per labral quadrant (anteroinferior, posteroinferior, and superior), and imaging features are described in detail. Online supplemental material is available for this article. ©RSNA, 2016.
Collapse
Affiliation(s)
- Tineke De Coninck
- From the Department of Radiology, Ghent University Hospital, Ghent, Belgium (T.D.C.); Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103 (S.S.N., C.B.C.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (M.T.); and Radiology Service, VA San Diego Healthcare System, San Diego, Calif (C.B.C.)
| | - Steven S Ngai
- From the Department of Radiology, Ghent University Hospital, Ghent, Belgium (T.D.C.); Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103 (S.S.N., C.B.C.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (M.T.); and Radiology Service, VA San Diego Healthcare System, San Diego, Calif (C.B.C.)
| | - Monica Tafur
- From the Department of Radiology, Ghent University Hospital, Ghent, Belgium (T.D.C.); Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103 (S.S.N., C.B.C.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (M.T.); and Radiology Service, VA San Diego Healthcare System, San Diego, Calif (C.B.C.)
| | - Christine B Chung
- From the Department of Radiology, Ghent University Hospital, Ghent, Belgium (T.D.C.); Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103 (S.S.N., C.B.C.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (M.T.); and Radiology Service, VA San Diego Healthcare System, San Diego, Calif (C.B.C.)
| |
Collapse
|
29
|
|
30
|
Ruiz Santiago F, Martínez Martínez A, Tomás Muñoz P, Pozo Sánchez J, Zarza Pérez A. Imaging of shoulder instability. Quant Imaging Med Surg 2017; 7:422-433. [PMID: 28932699 PMCID: PMC5594016 DOI: 10.21037/qims.2017.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/15/2017] [Indexed: 12/31/2022]
Abstract
This extended review tries to cover the imaging findings of the wide range of shoulder injuries secondary to shoulder joint instability. Usefulness of the different imaging methods is stressed, including radiography, computed tomography (CT) and magnetic resonance. The main topics to be covered include traumatic, atraumatic and minor instability syndromes. Radiography may show bone abnormalities associated to instability, including developmental and post-traumatic changes. CT is the best technique depicting and quantifying skeletal changes. MR-arthrography is the main tool in diagnosing the shoulder instability injuries.
Collapse
Affiliation(s)
- Fernando Ruiz Santiago
- Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
| | | | - Pablo Tomás Muñoz
- Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - José Pozo Sánchez
- Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
| | - Antonio Zarza Pérez
- Traumatology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
| |
Collapse
|
31
|
Celik H, Seckin MF, Kara A, Akman S. Isolated HAGL lesion after arthroscopic Bankart repair in a professional soccer player. PHYSICIAN SPORTSMED 2017; 45:199-202. [PMID: 28335687 DOI: 10.1080/00913847.2017.1309955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Post-traumatic anterior shoulder instability commonly occurs following an avulsion of capsulolabral complex from glenoid (Bankart lesion) or rarely after humeral avulsion of the glenohumeral ligaments (HAGL lesion). Arthroscopic Bankart repair offers high success rates of healing. However, trauma following the treatment may cause implant failure or re-avulsion of the treated tissue. We aim to present the diagnosis and treatment of an isolated HAGL lesion in a professional soccer player who had previously undergone arthroscopic Bankart repair.
Collapse
Affiliation(s)
- Haluk Celik
- a Department of Orthopaedics and Traumatology , Zonguldak Ataturk State Hospital , Zonguldak , Turkey
| | - Mustafa Faik Seckin
- b Department of Orthopaedics and Traumatology, Faculty of Medicine , Istanbul Bilim University , Istanbul , Turkey
| | - Adnan Kara
- c Department of Orthopaedics and Traumatology, Faculty of Medicine , Istanbul Medipol University , Istanbul , Turkey
| | - Senol Akman
- d Department of Orthopaedics and Traumatology , Florance Nightingale Hospital , Istanbul , Turkey
| |
Collapse
|
32
|
A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. Skeletal Radiol 2017; 46:149-160. [PMID: 27826700 DOI: 10.1007/s00256-016-2525-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) in superior labrum anterior to posterior lesions (type II-VII) of the shoulder. MATERIAL AND METHODS PubMed and Scopus search engines, an electronic search of articles was performed from inception to February 19, 2016. Diagnostic performance of index tests was compared by the summary area under receiver operator characteristic curve (AUROC). RESULTS AND CONCLUSIONS In all, 117 of 493 studies were eligible and 32 studies (2,013 shoulders) and 11 studies (1,498 shoulders) were evaluated with MRA and MRI. The summary sensitivity, specificity, likelihood ratio (positive and negative) and AUROC were 0.87 (95 % confidence interval, CI: 0.82, 0.91), 0.92 (95 %CI: 0.85, 0.95), 10.28 (95 %CI: 5.84, 18.08), 0.14 (95 %CI: 0.10, 0.20) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRA, and 0.76 (95 %CI: 0.61, 0.86), 0.87 (95 %CI: 0.71, 0.95), 5.89 (95 %CI: 2.5, 13.86), 0.28 (95 %CI: 0.17, 0.47) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRI. The diagnostic performance of MRA was superior to MRI by both direct and indirect comparisons for the detection of SLAP lesions.
Collapse
|
33
|
McHale KJ, Lavery KP, Vachon T. Imaging Instability in the Contact Athlete: What to Look For. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Abstract
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.
Collapse
|
35
|
Abstract
Glenohumeral joint instability is usually an intimidating topic for most radiologists due to both the complexity of related anatomical and biomechanical considerations and the increasing number of classifications and acronyms reported in the literature in association with this condition. In this short review, we aim to demystify glenohumeral instability by first focusing on the relevant anatomy and pathophysiology. Second, we will review what the important imaging findings are and how to describe them for the clinician in the most relevant yet simple way. The role of the radiologist in assessing glenohumeral instability lesions is to properly describe the stabilizing structures involved (bone, soft-tissue stabilizers, and their periosteal insertion) to localize them and to attempt to characterize them as acute or chronic. Impaction fractures on the glenoid and humeral sides are important to specify, locate, and quantify. In particular, the description of soft-tissue stabilizers should include the status of the periosteal insertion of the capsulo-labro-ligamentous complex. Finally, any associated cartilaginous or rotator cuff tendon lesion should be reported to the clinician.
Collapse
|
36
|
Luo TD, Poehling GG, Freehill MT. Review of Arciero's article (1994) on arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations: does the same hold true in 2016? J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
37
|
Advanced imaging of glenohumeral instability: the role of MRI and MDCT in providing what clinicians need to know. Emerg Radiol 2016; 24:95-103. [DOI: 10.1007/s10140-016-1429-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
|
38
|
Roy EA, Cheyne I, Andrews GT, Forster BB. Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder. Radiology 2016; 278:316-32. [PMID: 26789600 DOI: 10.1148/radiol.2015150364] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.
Collapse
Affiliation(s)
- Elizabeth A Roy
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Ian Cheyne
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Gordon T Andrews
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Bruce B Forster
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| |
Collapse
|
39
|
MR-arthrography and CT-arthrography in sports-related glenolabral injuries: a matched descriptive illustration. Insights Imaging 2016; 7:167-77. [PMID: 26746976 PMCID: PMC4805613 DOI: 10.1007/s13244-015-0462-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 01/02/2023] Open
Abstract
The combination of a large range of motion and insufficient bony stabilization makes the glenohumeral joint susceptible to injuries including dislocation in young athletes. Magnetic resonance arthrography (MR-arthrography) and computed tomography arthrography (CT-arthrography) play an important role in the preoperative workup of labroligametous injuries. This paper illustrates MR-arthrography and CT-arthrography findings acquired at the same time on the same subjects to illustrate common causes and sequelae of shoulder instability. Teaching Points • MR-arthrography and CT-arthrography are equivalent for SLAP and full-thickness rotator cuff tears.• CT-arthrography is superior in evaluating osseous defects and cartilage surface lesions.• MR-arthrography is superior in evaluating intrasubstance and extra-articular tendinous injuries.
Collapse
|
40
|
Abstract
Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to the causative factors as the pathogenesis of instability plays an important role with respect to treatment options. Instabilities are classified into traumatic and atraumatic instabilities as part of a multidirectional instability syndrome and into microtraumatic instabilities.For diagnostics plain radiographs ("trauma series") are performed to document shoulder dislocation and its successful repositioning. Direct magnetic resonance (MR) arthrography is the most important imaging modality for delineation of the different injury patterns of the labral-ligamentous complex and bony structures. Monocontrast computed tomography (CT) arthrography with the use of multidetector CT scanners represents an alternative imaging modality; however, MR imaging should be preferred in the work-up of shoulder instabilities due to the mostly younger age of patients.
Collapse
Affiliation(s)
- K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland,
| | | |
Collapse
|
41
|
van Grinsven S, van Loon C, van Gorp M, van Kints M, Konings P, van Kampen A. A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability. Eur J Radiol 2015; 84:2242-9. [DOI: 10.1016/j.ejrad.2015.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 01/27/2023]
|
42
|
van Grinsven S, Nijenhuis TA, Konings PC, van Kampen A, van Loon CJM. Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study. J Shoulder Elbow Surg 2015; 24:1405-12. [PMID: 26175312 DOI: 10.1016/j.jse.2015.05.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability. METHODS Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. κ Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P < .05, McNemar test) were calculated per lesion and overall per the 7 lesion types. RESULTS The overall κ between the individual radiologists (κ = 0.51, κ = 0.46) and orthopaedic surgeons (κ = 0.46, κ = 0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team. CONCLUSION Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.
Collapse
Affiliation(s)
- Susan van Grinsven
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Thijs A Nijenhuis
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Peer C Konings
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Albert van Kampen
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
43
|
|
44
|
Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol 2014; 25:961-9. [PMID: 25377772 DOI: 10.1007/s00330-014-3469-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/13/2014] [Accepted: 10/15/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the diagnostic performance of multi-detector CT arthrography (CTA) and 1.5-T MR arthrography (MRA) in detecting hyaline cartilage lesions of the shoulder, with arthroscopic correlation. PATIENTS AND METHODS CTA and MRA prospectively obtained in 56 consecutive patients following the same arthrographic procedure were independently evaluated for glenohumeral cartilage lesions (modified Outerbridge grade ≥2 and grade 4) by two musculoskeletal radiologists. The cartilage surface was divided in 18 anatomical areas. Arthroscopy was taken as the reference standard. Diagnostic performance of CTA and MRA was compared using ROC analysis. Interobserver and intraobserver agreement was determined by κ statistics. RESULTS Sensitivity and specificity of CTA varied from 46.4 to 82.4 % and from 89.0 to 95.9 % respectively; sensitivity and specificity of MRA varied from 31.9 to 66.2 % and from 91.1 to 97.5 % respectively. Diagnostic performance of CTA was statistically significantly better than MRA for both readers (all p ≤ 0.04). Interobserver agreement for the evaluation of cartilage lesions was substantial with CTA (κ = 0.63) and moderate with MRA (κ = 0.54). Intraobserver agreement was almost perfect with both CTA (κ = 0.94-0.95) and MRA (κ = 0.83-0.87). CONCLUSION The diagnostic performance of CTA and MRA for the detection of glenohumeral cartilage lesions is moderate, although statistically significantly better with CTA. KEY POINTS • CTA has moderate diagnostic performance for detecting glenohumeral cartilage substance loss. • MRA has moderate diagnostic performance for detecting glenohumeral cartilage substance loss. • CTA is more accurate than MRA for detecting cartilage substance loss.
Collapse
|
45
|
van Grinsven S, Hagenmaier F, van Loon CJM, van Gorp MJ, van Kints MJ, van Kampen A. Does the experience level of the radiologist, assessment in consensus, or the addition of the abduction and external rotation view improve the diagnostic reproducibility and accuracy of MRA of the shoulder? Clin Radiol 2014; 69:1157-64. [PMID: 25218253 DOI: 10.1016/j.crad.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/05/2014] [Accepted: 07/09/2014] [Indexed: 12/21/2022]
Abstract
AIM To prospectively evaluate the influence of observer experience, consensus assessment, and abduction and external rotation (ABER) view on the diagnostic performance of magnetic resonance arthrography (MRA) in patients with traumatic anterior-shoulder instability (TASI). MATERIALS AND METHODS Fifty-eight MRA examinations (of which 51 had additional ABER views) were assessed by six radiologists (R1-R6) and three teams (T1-T3) with different experience levels, using a seven-lesion standardized scoring form. Forty-five out of 58 MRA examination findings were surgically confirmed. Kappa coefficients, sensitivity, specificity, and differences in percent agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per seven lesion types to assess diagnostic reproducibility and accuracy. RESULTS Overall kappa ranged from poor (k = 0.17) to moderate (k = 0.53), sensitivity from 30.6-63.5%, and specificity from 73.6-89.9%. Overall, the most experienced radiologists (R1-R2) and teams (T2-T3) agreed significantly more than the lesser experienced radiologists (R3-R4: p = 0.014, R5-R6; p = 0.018) and teams (T2-T3: p = 0.007). The most experienced radiologist (R1, R2, R3) and teams (T1, T2) were also consistently more accurate than the lesser experienced radiologists (R4, R5, R6) and team (T3). Significant differences were found between R1-R4 (p = 0.012), R3-R4 (p = 0.03), and T2-T3 (p = 0.014). The overall performance of consensus assessment was systematically higher than individual assessment. Significant differences were established between T1-T2 and radiologists R3-R4 (p<0.001, p = 0.001) and between T2 and R3 (p<0.001/p = 0.001) or R4 (p = 0.050). No overall significant differences were found between the radiologists' assessments with and without ABER. CONCLUSION The addition of ABER does not significantly improve overall diagnostic performance. The radiologist's experience level and consensus assessment do contribute to higher reproducibility and accuracy.
Collapse
Affiliation(s)
- S van Grinsven
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands.
| | - F Hagenmaier
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - C J M van Loon
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - M J van Gorp
- Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - M J van Kints
- Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - A van Kampen
- Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6501 HB, Nijmegen, The Netherlands
| |
Collapse
|
46
|
Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging. Skeletal Radiol 2014; 43:1085-92. [PMID: 24805966 DOI: 10.1007/s00256-014-1894-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/03/2014] [Accepted: 04/08/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements. SUBJECTS AND METHODS Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18-55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3-200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9-73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard. RESULTS Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient = 0.80-0.82; r = 0.81-0.86). The first and second observers' measurements showed strong (r = 0.76) and moderate (r = 0.69) interreader correlation, respectively, with arthroscopic measurements. CONCLUSIONS Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist.
Collapse
|
47
|
[Magnetic resonance imaging of the shoulder: impingement and instability related abnormalities--update 2013]. Radiologe 2014; 53:917-34. [PMID: 24068294 DOI: 10.1007/s00117-013-2565-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the diagnosis and differentiation of numerous shoulder abnormalities and chronic shoulder pain. Important indications for MRI are assessment of the rotator cuff and the labrocapsular complex. The assessment of the rotator cuff muscles is crucial. The value of MR arthrography is discussed. The potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities, shoulder instability-related lesions and the assessment of pathological conditions of the long biceps tendon. The following article describes the most common pathological findings of the shoulder joint and gives a description of the relevant findings for the orthopedic shoulder surgeon. The current article represents an update of an article previously published in 2006 with the same title (Zanetti and Saupe, Radiologe 46:79-89, 2006).
Collapse
|
48
|
|
49
|
Reis Silva H, Uosyte R, Clements DN, Bergkvist GT, Schwarz T. Computed tomography and positive contrast computed tomographic arthrography of the canine shoulder: normal anatomy and effects of limb position on visibility of soft tissue structures. Vet Radiol Ultrasound 2013; 54:470-7. [PMID: 23721305 DOI: 10.1111/vru.12054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 04/25/2013] [Indexed: 11/28/2022] Open
Abstract
Soft tissue injuries of the shoulder are an important cause of forelimb lameness in dogs. The objectives of this canine cadaver study were to describe normal anatomy of shoulder soft tissue structures using computed tomography (CT) and computed tomographic arthrography (CTA) and to determine the effects of positioning on visualization of shoulder soft tissue structures. Thirteen forelimbs were removed from eight canine cadavers. Two forelimbs were used for contrast dose optimization. For the remaining 11 forelimbs, shoulder CT and CTA were performed using three defined joint angles (140°, 90°, and 70°). For three forelimbs, CT and CTA images were compared with frozen anatomic sections to describe normal anatomy. Ten forelimbs were used for analysis of positioning effects. Soft tissue structures evaluated were the joint capsule, cartilage, ligaments, tendons, and muscles. A visual assessment score was assigned to each structure using a consensus of two observers. The range and mode of scores were calculated and compared for each modality and limb position. The shoulder joint capsule and medial and lateral glenohumeral ligaments were completely visible with CTA. All tendons and muscles were visualized in all the examinations except for the teres minor muscle tendon and the coracobrachialis muscle, which were not visible on all scans. Positioning the limb in an extended position significantly improved visualization of most soft tissue shoulder structures. Shoulder cartilage was best seen with CTA and with neutral or flexed positioning of the shoulder. Findings indicated that both CT and CTA are feasible imaging techniques for visualization of soft tissue structures of the canine shoulder.
Collapse
Affiliation(s)
- Henrique Reis Silva
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, University of Edinburgh, Roslin, Midlothian, Scotland, EH25 9RG, UK
| | | | | | | | | |
Collapse
|