An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography

2021 ◽  
pp. 028418512110645
Author(s):  
Gokhan Ongen ◽  
Gokhan Gokalp ◽  
Omer Fatih Nas
Keyword(s):  
Magnetic Resonance ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Shoulder Arthroscopy ◽  
Magnetic Resonance Arthrography ◽  
Proton Density ◽  
Slap Lesions ◽  
Significant Difference ◽  
Operation Results ◽  
Bankart Lesions

Background Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. Purpose To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. Material and Methods In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. Results According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images ( P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% ( P = 0.015). Conclusion The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

scholarly journals Correlation of clinical examination, ultrasound, magnetic resonance imaging and arthroscopy as diagnostic tools in shoulder pathology

2020 ◽  
Vol 6 (2) ◽  
pp. 247
Author(s):  
Sondipon Biswas ◽  
Naman Kanodia ◽  
Rajat Tak ◽  
Siddharth Agrawal ◽  
Kiran Shankar Roy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Shoulder Arthroscopy ◽  
Resonance Imaging ◽  
Shoulder Pathologies

<p class="abstract"><strong>Background:</strong> Shoulder pathologies can cause significant pain, discomfort, and affect the activity of daily living. The aim of this study was to compare the efficacy of clinical examination, ultrasound, magnetic resonance imaging (MRI) with shoulder arthroscopy in diagnosing various shoulder pathologies, considering shoulder arthroscopy as the gold standard tool.</p><p class="abstract"><strong>Methods:</strong> This was a prospective, comparative study conducted over 35 patients, between 18-75 years of age presenting with chronic shoulder pain or instability of more than 2 months duration. All patients were examined clinically, followed by high resolution ultrasound, MRI, arthroscopy of the affected shoulder.<strong></strong></p><p class="abstract"><strong>Results:</strong> The sensitivity and specificity of ultrasonography (USG) for diagnosing full thickness tear was 100% each and for MRI was 88% and 100% respectively. For subacromial impingement USG had sensitivity of 66.67%, specificity of 94.12%, positive predictive value of 50% and negative predictive value of 88.89%. For rotator cuff tear USG had sensitivity of 92.86%, specificity of 50%, positive predictive value of 81.25% and negative predictive value of 75% considering shoulder arthroscopy as gold standard.</p><p class="abstract"><strong>Conclusions:</strong> USG and MRI both are sensitive techniques for diagnosing of rotator cuff pathologies. USG has high accuracy in diagnosing partial thickness tears as compare to MRI. MRI proved to be superior in estimation of site and extent of tear. Considering shoulder arthroscopy as gold standard, it can be reserved for patients with suspicious of USG/MRI findings or those who may need surgical intervention simultaneously.</p>

The Crank Test, the O'Brien Test, and Routine Magnetic Resonance Imaging Scans in the Diagnosis of Labral Tears

2002 ◽  
Vol 30 (6) ◽  
pp. 806-809 ◽  
Author(s):  
William B. Stetson ◽  
Kevin Templin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Shoulder Arthroscopy ◽  
Rotator Cuff Tears ◽  
Resonance Imaging ◽  
Routine Magnetic Resonance Imaging ◽  
Labral Tears

Background Tears of the superior labrum of the shoulder, anterior to posterior, are difficult to diagnose clinically. Purpose We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears. Study Design Nonrandomized prospective study. Methods Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain. Results The crank test result was positive in 29 patients (45%), and the O'Brien test was positive in 41 patients (63%). The crank test had a positive predictive value of 41%, was 56% specific, 46% sensitive, and had a negative predictive value of 61%. The O'Brien test had a positive predictive value of 34%, was 31% specific, 54% sensitive, and had a negative predictive value of 50%. Magnetic resonance imaging had a positive predictive value of 63%, was 92% specific, 42% sensitive, and had a negative predictive value of 83%. Conclusions The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum. Results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears.

scholarly journals Medial Subluxation or Dislocation of the Biceps on Magnetic Resonance Arthrography Is Reliably Correlated with Concurrent Subscapularis Full-Thickness Tears Confirmed Arthroscopically

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ji-Sang Yoon ◽  
Sung-Jae Kim ◽  
Yun-Rak Choi ◽  
Wonyong Lee ◽  
Sang Ho Kim ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Arthroscopic Repair ◽  
Magnetic Resonance Arthrography ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Arthroscopic Examination ◽  
The Relationship ◽  
High Chance

Background. The purpose of this study was to investigate the relationship between biceps medial subluxation/dislocation on the magnetic resonance arthrography (MRA) imaging and subscapularis full-thickness tear confirmed arthroscopically. We hypothesized that presence of a biceps medial subluxation or dislocation would strongly indicate a subscapularis full-thickness tear. Methods. A total of 432 consecutive patients who underwent arthroscopic repair for rotator cuff tears with/without subscapularis tears at our institute were retrospectively reviewed. The inclusion criterion of this study was preoperative MRA images taken within 6 months of arthroscopic repair. The presence of medial subluxation/dislocation was evaluated on the preoperative MRA images, and subscapularis tear was confirmed on arthroscopic examination. Results. Biceps subluxation/dislocation was identified in 46 of the 432 patients on MRA. Forty-five of these 46 patients also had a subscapularis full-thickness tear identified in arthroscopic examination. Among the 386 patients who did not have biceps subluxation or dislocation, 54 patients had a subscapularis full-thickness tear diagnosed arthroscopically. The presence of a biceps subluxation/dislocation could predict a subscapularis full-thickness tear with sensitivity of 45% (45/99), specificity of 99% (332/333), positive predictive value of 98% (45/46), negative predictive value of 86% (332/386), and accuracy of 87% (377(45 +332)/432). Conclusion. Medial subluxation/dislocation of the biceps on MRA images was highly associated with a concurrent subscapularis full-thickness tear which was confirmed arthroscopically. This association had 99% specificity and 98% positive predictive value. Therefore, if a biceps subluxation/dislocation is identified on MRA images, there is a high chance that a concurrent subscapularis full-thickness tear exists.

scholarly journals Comparison of magnetic resonance arthrography with arthroscopy for imaging of shoulder injuries: retrospective study

2017 ◽  
Vol 99 (4) ◽  
pp. 271-274 ◽  
Author(s):  
R Saqib ◽  
J Harris ◽  
L Funk
Keyword(s):  
Magnetic Resonance ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Loose Bodies ◽  
Slap Lesions ◽  
Labral Tears ◽  
Shoulder Disorders

BACKGROUND Arthroscopy is the established ‘gold standard’ diagnostic investigation for detection of shoulder disorders. We aimed to compare the diagnostic accuracy of arthroscopy with magnetic resonance arthrography (MRA) for detection of shoulder disorders. METHODS Patients who underwent arthroscopy by a single surgeon and preoperative MRA between February 2011 and March 2012 for shoulder instability were identified. MRAs were reported by experienced musculoskeletal radiologists. Labral tears, anterior labral tears, superior labral anterior posterior (SLAP) lesions, posterior labral tears, rotator-cuff tears (RCTs), osteoarthritis, loose bodies and Hill–Sachs lesions were identified. Sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. RESULTS A total of 194 patients were identified. The sensitivity and specificity for anterior labral tears was 0.60 and 0.92, SLAP lesions was 0.75 and 0.81, posterior labral tears was 0.57 and 0.96, any labral tear was 0.87 and 0.76, Hill–Sachs lesions was 0.91 and 0.91, RCTs was 0.71 and 0.86, osteoarthritis was 0.72 and 0.95, and loose bodies was 0.22 and 0.96, respectively. The positive predictive value and negative predictive value for anterior labral tears were 0.88 and 0.71, SLAP lesions was 0.64 and 0.88, posterior labral tears was 0.74 and 0.45, any labral tear was 0.89 and 0.71, Hill–Sachs lesions was 0.66 and 0.98, RCTs was 0.47 and 0.95, osteoarthritis was 0.70 and 0.95, and loose bodies was 0.27 and 0.95, respectively. CONCLUSIONS MRA has high diagnostic accuracy for labral tears and Hill–Sachs lesions, but whether MRA should be the first-line imaging modality is controversial.

PREDICTIVE VALUE OF LOW AT III LEVELS FOR THE OCCURRENCE OF IVH, IRDS AND DEATH IN PREMATURE NEONATES

1987 ◽  
Author(s):  
W van den Berg ◽  
M Peters ◽  
C Breederveld ◽  
J W ten Cate ◽  
J G Koppe
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Distress Syndrome ◽  
Peripheral Vein ◽  
Premature Neonates ◽  
Significant Difference ◽  
At Iii ◽  
Diffuse Intravascular Coagulation ◽  
Idiopathic Respiratory Distress Syndrome ◽  
A Prospective Study

The observation of AT III deficiency in premature neonates with Idiopathic Respiratory Distress Syndrome (IRDS), suggests a positive predictive value for a poor outcome. The underlying diffuse intravascular coagulation could generate serious hemorrhagic complications like Peri/Intraventricular Hemorrhage (IVH).A prospective study was performed in consecutively born neonates to assess the predictive value of low AT III for theoccurrence of IVH, (gr. III/IV), IRDS, and death. Eighty-one neonates were included in the study during a period of 5 months. AT III levels were determined immediately after birth by a chromogenic substrate assay. Values in umbilical cord blood were identical with values in capillary or peripheral vein blood samples taken within 6 hours after birth. There was no correlation between AT III values and gestational age (r: 0.18). Twenty-four neonates with IRDS showed a mean AT III value of 0.23 U/ml (S. D. ± 0.07 U/ml) which was significantly lower than a mean AT III value of 0.35 U/ml (S. D. ± 0.1 U/ml) for neonates without IRDS (p ≺0.00005). When IVH gr. III/IV was diagnosed in neonates having IRDS (8/24) no significant difference in mean AT IIIact was observed with respect to jnean AT III levels of remaining neonates without this complication. No death occurred in neonates without IRDS. Mean AT IIIact (0.21 U/ml) in neonates with IRDS who died (9/24) was low compared with mean AT III levels of neonates with IRDS who survived (0.25 U/ml), but did not reach significance (p≻0.1). Assuming a critical value of AT III of 20% a positive predictive value of 89% for IRDS, 44% for IVH, and 56% for death was calculated. It is concluded that low AT Illact levels have a high predictive value for IRDS.

scholarly journals Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

2014 ◽  
Vol 47 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Vilson Lacerda Brasileiro Junior ◽  
Aníbal Henrique Barbosa Luna ◽  
Marcelo Augusto Oliveira de Sales ◽  
Tânia Lemos Coelho Rodrigues ◽  
Priscilla Lopes da Fonseca Abrantes Sarmento ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Carotid Arteries ◽  
Panoramic Radiography ◽  
Digital Panoramic Radiography ◽  
Significant Difference ◽  
Mcnemar’S Test ◽  
Sensitivity Specificity

Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.

Clinical Assessment of Three Common Tests for Superior Labral Anterior-Posterior Lesions

2002 ◽  
Vol 30 (6) ◽  
pp. 810-815 ◽  
Author(s):  
Edward G. McFarland ◽  
Tae Kyun Kim ◽  
Richard M. Savino
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Shoulder Arthroscopy ◽  
Control Group ◽  
Type I ◽  
Specific Test ◽  
Slide Test ◽  
Posterior Lesion ◽  
Sensitivity Specificity ◽  
Anterior Posterior

Background Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions. Hypothesis We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion. Study Design Case-control study. Methods The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Results At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators. Conclusions The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.

scholarly journals Mid-arm and Chest Circumferences for Estimating Low Birthweight

2018 ◽  
Vol 33 (1-2) ◽  
pp. 24-31
Author(s):  
Achmad Surjono
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Low Birthweight ◽  
Newborn Infants ◽  
Roc Curves ◽  
Strong Correlations ◽  
Significant Difference ◽  
A Prospective Study

A prospective study was conducted to assess the diagnostic performance of mid-arm and chest circumferences on low birth weights in 1033 singleton newborn infants. The proportion of low birth weight was 11.7%. Strong correlations on birth weight (P<0.001) were found for mid-arm (r-0.85) and chest (r=0.86) circumferences. A mid-arm circumference of ≤9,5 cm was considered as cut-off level for low birth weight, with a sensitivity of 0.818, specificity 0.956 and positive predictive value 0. 712. Whereas that of chest circumference wa ≤29.5 cm with a sensitivity of 0. 785, specificity 0.895 and positive predictive value 0.497. Receiver operating characteristic (ROC) curves were used to compare their diagnostic accuracy. The area under these two ROC(± SE) were 0.954 ± 0.011 for mid-arm and 0.945 ± 0.012 for chest circumferences, respectively. Both areas showed significant differences with the area under chance line. No statistically significant difference was found between the area under ROC of mid-arm and chest circumferences. The results showed that mid-arm and chest circumferences as simple and reliable measurements can be used in estimating low birth weight, in areas where the accurate weighing of newborn infants is not feasible.

scholarly journals Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Felix Wuennemann ◽  
Laurent Kintzelé ◽  
Felix Zeifang ◽  
Michael W. Maier ◽  
Iris Burkholder ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Predictive Value ◽  
Gold Standard ◽  
Proton Density ◽  
Diagnostic Challenge ◽  
Cohen’S Kappa ◽  
Slap Lesions ◽  
Cohen's Kappa ◽  
Sensitivity Specificity ◽  
Interreader Agreement

Abstract Background Superior labral anterior to posterior (SLAP) lesions remain a clinical and diagnostic challenge in routine (non-arthrographic) MR examinations of the shoulder. This study prospectively evaluated the ability of 3D-Multi-Echo-Data-Image-Combination (MEDIC) compared to that of routine high resolution 2D-proton-density weighted fat-saturated (PD fs) sequence using 3 T-MRI to detect SLAP lesions using arthroscopy as gold standard. Methods Seventeen consecutive patients (mean age, 51.6 ± 14.8 years, 11 males) with shoulder pain underwent 3 T MRI including 3D-MEDIC and 2D-PD fs followed by arthroscopy. The presence or absence of SLAP lesions was evaluated using both sequences by two independent raters with 4 and 14 years of experience in musculoskeletal MRI, respectively. During arthroscopy, SLAP lesions were classified according to Snyder’s criteria by two certified orthopedic shoulder surgeons. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 3D-MEDIC and 2D-PD fs for detection of SLAP lesions were calculated with reference to arthroscopy as a gold standard. Interreader agreement and sequence correlation were analyzed using Cohen’s kappa coefficient. Figure 1 demonstrates the excellent visibility of a proven SLAP lesion using the 3D-MEDIC and Fig. 2 demonstrates a false-positive case. Results Arthroscopy revealed SLAP lesions in 11/17 patients. Using 3D-MEDIC, SLAP lesions were diagnosed in 14/17 patients by reader 1 and in 13/17 patients by reader 2. Using 2D-PD fs, SLAP lesions were diagnosed in 11/17 patients by reader 1 and 12/17 patients for reader 2. Sensitivity, specificity, PPV, and NPV of 3D-MEDIC were 100.0, 50.0, 78.6, and 100.0% for reader 1; and 100.0, 66.7, 84.6, and 100% for reader 2, respectively. Sensitivity, specificity, PPV, and NPV of 2D-PD fs were 90.9, 83.3, 90.9, and 83.3% for reader 1 and 100.0, 83.3, 91.7, and 100.0% for reader 2. The combination of 2D-PD fs and 3D-MEDIC increased specificity from 50.0 to 83.3% for reader 1 and from 66.7 to 100.0% for reader 2. Interreader agreement was almost perfect with a Cohen’s kappa of 0.82 for 3D-MEDIC and 0.87 for PD fs. Conclusions With its high sensitivity and NPV, 3D-MEDIC is a valuable tool for the evaluation of SLAP lesions. As the combination with routine 2D-PD fs further increases specificity, we recommend incorporation of 3D-MEDIC as an additional sequence in conventional shoulder protocols in patients with non-specific shoulder pain.

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