Agreement between Arthroscopy and Saline Magnetic Resonance Shoulder Arthrography in Adolescent Patients - Evaluation of Location and Extent of Injury of Labral Tears

The inferior glenohumeral ligament (IGHL) complex is commonly assessed by both magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrogram. Our study aimed to compare the accuracy of MR arthrogram compared to MRI using arthroscopic correlation as the gold standard. A retrospective review of cases reporting an IGHL injury was performed. 77 cases met inclusion criteria, while 5 had arthroscopic reports that directly confirmed or refuted the presence of IGHL injury. Two arthroscopic reports confirmed concordant IGHL injuries, while 3 arthroscopic reports mentioned discordant findings compared to MR. Interestingly, all three discordant cases involved MR arthrogram. Findings included soft tissue edema, fraying of the axillary pouch fibers, and cortical irregularity of the humeral neck. Of the two concordant cases, one was diagnosed by MRI, revealing an avulsion of the anterior band, while the second was diagnosed by MR arthrogram showing ill-defined anterior band fibers. Many cases involved rotator cuff or labral tears, which may have been the focus of care for providers, given their importance for shoulder stability. Additionally, a lack of diagnostic confidence in MR reports may have influenced surgeons in the degree to which they assessed the IGHL complex during arthroscopy. In conclusion, radiologists seemed more likely to make note of IGHL injuries when MR arthrograms were performed; meanwhile, all three discordant cases involved MR arthrogram reads. Therefore, additional larger studies are needed with arthroscopic correlation to better elucidate MR findings that confidently suggest injury to the IGHL complex, in order to avoid false positive radiology reports.

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Confirming the Presence of Unrecognized Meniscal Injuries on Magnetic Resonance Imaging in Pediatric and Adolescent Patients With Anterior Cruciate Ligament Tears

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001331 ◽

2019 ◽

Vol 39 (9) ◽

pp. e661-e667 ◽

Cited By ~ 1

Author(s):

Alana M. Munger ◽

Nicholas R. Gonsalves ◽

Natalya Sarkisova ◽

Emily Clarke ◽

Curtis D. VandenBerg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Anterior Cruciate Ligament ◽

Magnetic Resonance ◽

Cruciate Ligament ◽

Resonance Imaging ◽

Adolescent Patients ◽

Anterior Cruciate ◽

Cruciate Ligament Tears

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

The American Journal of Sports Medicine ◽

10.1177/03635465020300060901 ◽

2002 ◽

Vol 30 (6) ◽

pp. 806-809 ◽

Cited By ~ 91

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.

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Direct magnetic resonance (MR) shoulder arthrography: posterior approach under ultrasonographic guidance and abduction (PAUGA)

La radiologia medica ◽

10.1007/s11547-012-0879-6 ◽

2012 ◽

Vol 118 (5) ◽

pp. 806-815 ◽

Cited By ~ 3

Author(s):

R. F. Grasso ◽

E. Faiella ◽

P. Cimini ◽

R. L. Cazzato ◽

G. Luppi ◽

...

Keyword(s):

Magnetic Resonance ◽

Posterior Approach ◽

Shoulder Arthrography ◽

Ultrasonographic Guidance

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Diagnostic Accuracy of Magnetic Resonance Arthrography in Detecting Intra-articular Pathology Associated with Femoroacetabular Impingement

Joints ◽

10.1055/s-0038-1660839 ◽

2018 ◽

Vol 06 (02) ◽

pp. 104-109

Author(s):

Christian Carulli ◽

Filippo Tonelli ◽

Tommaso Melani ◽

Michele Pietragalla ◽

Alioscia De Renzis ◽

...

Keyword(s):

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Femoroacetabular Impingement ◽

Predictive Value ◽

Magnetic Resonance Arthrography ◽

Loose Bodies ◽

Level Of Evidence ◽

Chondral Lesions ◽

Labral Tears ◽

Sensitivity Specificity

Purpose The aim of this study was to assess the diagnostic accuracy of magnetic resonance arthrography (MRA) in the detection of intra-articular lesions of the hip in patients affected by femoroacetabular impingement (FAI) by using arthroscopy as reference standard. Methods Twenty-nine consecutive hip arthroscopies performed in 24 patients were considered for the study. Patients had a mean age of 38.3 years. Ultrasound-guided 1.5-T MRA was performed with precontrast short tau inversion recovery, T1-weighted and PD coronal, T1-weighted, and T2-weighted axial with 3-mm-thick slice sequences, and postcontrast T1-weighted fat saturation MRA (Fat-SAT) axial, coronal and oblique sagittal, and T1-weighted Vibe 3D coronal sequences with MPR sagittal, axial, and radial reconstructions with 2-mm-thick slice and coronal density protonil (DP) Fat-SAT. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRA were evaluated by comparison arthroscopy for the following intra-articular findings: acetabular and femoral chondral lesions, labral degeneration, labral tears, synovitis, ligamentum teres (LT) tears, CAM lesions, pincer lesions, loose bodies, and osteophytes. Results An absolute per cent agreement (100%) was observed for all the variables in the assessment of CAM lesions. Sensitivity, specificity, PPV, and NPV of MRA were 100, 68.4, 72.7, and 100%, respectively, for acetabular chondral lesions; 100, 50, 47.3, and 100%, respectively, for femoral chondral lesions; 33, 85, 20, and 91.6%, respectively, for labral tears; 95, 71, 91.3, and 83.3%, respectively, for labral degeneration; 100, 88, 57.1, and 100%, respectively, for LT tears; 33.3, 85, 50, and 73.9%, respectively, for pincer lesions; 50, 96, 66.6, and 92.3%, respectively, for intra-articular loose bodies; and 100, 73.9, 50, and 100%, respectively, for osteophytes. Conclusion MRA may play an important role in detecting intra-articular lesions associated with FAI. This might be helpful for the preoperative planning before hip arthroscopy. Level of Evidence This is a Level 2, diagnostic accuracy study compared with gold standard.

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Preclinical evaluation of an integrated robotic system for magnetic resonance imaging guided shoulder arthrography

Journal of Medical Imaging ◽

10.1117/1.jmi.6.2.025006 ◽

2019 ◽

Vol 6 (02) ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Niravkumar Patel ◽

Jiawen Yan ◽

Reza Monfaredi ◽

Karun Sharma ◽

Kevin Cleary ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Robotic System ◽

Resonance Imaging ◽

Preclinical Evaluation ◽

Shoulder Arthrography

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Magnetic resonance imaging evaluation of meniscoid superior labrum: normal variant or superior labral tear

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0083 ◽

2016 ◽

Vol 49 (4) ◽

pp. 220-224 ◽

Cited By ~ 5

Author(s):

Marcelo Novelino Simão ◽

Emily N. Vinson ◽

Charles E. Spritzer

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Final Analysis ◽

Labral Tear ◽

Resonance Imaging ◽

Imaging Evaluation ◽

Magnetic Resonance Imaging Evaluation ◽

Superior Labrum ◽

Labral Tears ◽

Operative Report

Abstract Objective: The objective of this study was to determine the incidence of a "meniscoid" superior labrum. Materials and Methods: This was a retrospective analysis of 582 magnetic resonance imaging examinations of shoulders. Of those 582 examinations, 110 were excluded, for a variety of reasons, and the final analysis therefore included 472 cases. Consensus readings were performed by three musculoskeletal radiologists using specific criteria to diagnose meniscoid labra. Results: A meniscoid superior labrum was identified in 48 (10.2%) of the 472 cases evaluated. Arthroscopic proof was available in 21 cases (43.8%). In 10 (47.6%) of those 21 cases, the operative report did not include the mention a superior labral tear, thus suggesting the presence of a meniscoid labrum. In only one of those cases were there specific comments about a mobile superior labrum (i.e., meniscoid labrum). In the remaining 11 (52.4%), surgical correlation demonstrated superior labral tears. Conclusion: A meniscoid superior labrum is not an infrequent finding. Depending upon assumptions and the requirement of surgical proof, the prevalence of a meniscoid superior labrum in this study was between 2.1% (surgically proven) and 4.8% (projected). However, superior labral tears are just as common and are often confused with meniscoid labra.

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Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1017 ◽

2012 ◽

Vol 2 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Ankur M Manvar ◽

Sheetal M Bhalani ◽

Grant E Garrigues ◽

Nancy M Major

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Signal Intensity ◽

Labral Tear ◽

High Signal ◽

Resonance Imaging ◽

Superior Labrum ◽

Labral Tears ◽

Biceps Anchor ◽

Labral Pathology

ABSTRACT Objective To improve the magnetic resonance imaging (MRI) and magnetic resonance arthrogram (MRA) interpretation of a ‘meniscoid-type’ superior labrum vs a superior labral tear by evaluation of a simple sign. Materials and methods Retrospective analysis of our institution's shoulder MRIs and MRAs yielded 144 patients thought to have a superior labral tear. Fifty-five patients had arthroscopy. Analysis of the orthopaedic database for superior labral repair surgeries performed in the same time frame yielded seven additional patients without prospective MRI/MRA diagnosis of superior labral tear. Results Two of 17 (11.8%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy. Both cases failed to have extension of high signal intensity behind the biceps anchor to the most posterior oblique coronal image. Nine of 38 (23.7%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy, but a meniscoid-type superior labrum. Four of seven patients known to have superior labral tears by arthroscopy but incorrectly diagnosed as meniscoid-type superior labrum on MRI or MRA, were retrospectively found to have extension of high signal intensity in the superior labrum to the most posterior image. Conclusion Signal abnormality that continues through the remainder of the superior labrum posterior to the biceps anchor indicates a superior labral tear. Absence of this sign in the setting of more anterior high signal under the labrum may indicate a meniscoid variant. Manvar AM, Bhalani SM, Garrigues GE, Major NM. Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging. The Duke Orthop J 2012;2(1):44-49.

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