Advanced shoulder imaging (original) (raw)
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MR and CT Arthrography of the Shoulder
Seminars in Musculoskeletal Radiology, 2012
The clinical application of shoulder arthrography was first described in 1933 by Oberholzer, who injected air into the glenohumeral joint to evaluate the structures of the axillary recess on conventional radiographs. 1,2 In the following decades the injection of iodinated contrast material using both blind and fluoroscopically guided techniques was routinely used to enhance the radiological evaluation of the symptomatic shoulder. By the 1980s CT arthrography became the procedure of choice over conventional arthrography due to its ability to delineate the soft tissue structures of the joint in cross section. Intra-articular injection of a solution containing dilute gadolinium-diethylenetriamine penta-acetic acid (DTPA) followed by T1-weighted imaging (direct MR arthrography) was first described in 1987 by Hajek and colleagues. 3 Due to its superior soft tissue contrast, MR arthrography gradually superseded the use of CT by the 1990s. Today, CT arthrography is most commonly used in claustrophobic individuals, patients with contraindications to MRI, and in some instances the postoperative shoulder containing metal. Rationale Although there continues to be discussion about the necessity and appropriate indications for shoulder arthrography, its use has several distinct advantages over conventional nonarthrographic imaging techniques. Direct arthrography results in joint distension and separates normal intra-articular structures that might otherwise lie in close apposition. Capsular distension can enhance visualization of small joint bodies and improve delineation of the rotator cuff undersurface, labrum, glenohumeral ligaments, long head of the biceps tendon, and other structures of the rotator interval. The presence of contrast in the glenohumeral joint increases the conspicuity of some rotator cuff and labral tears as well as chondral defects and increases diagnostic confidence when contrast is seen to enter these structures. MR arthrography also routinely uses T1-weighted fat-suppressed sequences, which impart excellent contrast as well as a higher signal-to-noise ratio than conventional T2-weighted fat-suppressed imaging. The compartmental integrity of the glenohumeral joint is also best assessed through the use of arthrography. Intra-articular injection of contrast into the shoulder can be particularly helpful in determining whether a
Current Protocols in Magnetic Resonance Imaging, 2002
The glenohumeral joint boasts the greatest range of motion of any peripheral joint in the body, but not without cost; it is also the most frequently dislocated joint in the body. Stability of this articulation is limited for two major reasons. The articulating surface of the glenoid is significantly smaller than that of the humeral head, and the joint capsule is redundant and provides little support. Generally speaking, the term instability when applied to the glenohumeral joint, refers to a recurrence of dislocation or subluxation. This is not an unexpected complication, given the complex biomechanics of this articulation, the sophisticated movement achieved, and the high performance demanded from the body. There is much debate and controversy surrounding the mechanism and imaging evaluation of shoulder instability. This unit will focus on an MR arthrography protocol for evaluation of glenohumeral joint instability.
MRI of shoulder instability: state of the art
Current problems in diagnostic radiology
In recent years, our understanding of normal anatomy and traumatic lesions of the glenoid labrum and the associated glenohumeral ligaments and joint capsule have grown substantially. Pathologic abnormalities are generally seen in individuals with an antecedent episode of shoulder trauma, typically involving a dislocation or a subluxation. These lesions can have a wide range of appearances and the radiologist must be familiar with them to make the correct diagnosis and avoid the potential pitfalls related to normal anatomic variations in the glenoid and capsuloligamentous structures. The purpose of this article is to review a variety of traumatic lesions involving the labral ligamentous complex in patients with glenohumeral instability. These lesions predominantly involve the inferior and anteroinferior supporting structures.
Surgeon Agreement on the Presence of Pathologic Anterior Instability on Shoulder Imaging Studies
Orthopaedic Journal of Sports Medicine, 2019
Background: In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI). Purpose: To assess the intra-and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI.
International Journal of Research in Orthopaedics, 2017
Shoulder instability is a common problem with annual incidence between 0.084%-1.7%. 1 There are 46%-100% incidence of recurrent dislocation for patients aged less than 40 years without surgical intervention, which decreases to 7%-15% after surgical stablization. 1 To improve the pre-operative planning and post-operative result of surgery, exact diagnosis of pathology and anatomy of labroligamentous structure is essential. Conventional computerized tomographic arthrography (CTA) has limited soft tissue contrast and spatial resolution which has led to it being replaced by conventional and contrast enhanced magnetic resonance imaging (MRI) of shoulder. 2-6 At present, magnetic resonance arthrography (MRA) of shoulder is well proven and useful technique for diagnosis of intraarticular lesions. 5,11 However it is still expensive and metal in the vicinity interferes with the true signal. Since multidetector CT (MDCT) was introduced in 1988, cross-sectional imaging has been revolutionized by the ABSTRACT Background: Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography (MDCTA) in shoulder instability and pain in throwing and its comparison to MR arthrography (MRA) and arthroscopy taking arthroscopy as gold standard. Methods: 20 patients with history of recurrent shoulder dislocation in activity were included in this study. After detailed clinical examination, each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician. Results: At arthroscopy, 10 Bankart's lesions, 7 Hill Sachs lesion, 6 SLAP lesion, 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and 1 supraspinatus fraying were visualized in 20 shoulders. For Bankart's lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 83.3%. MRA has sensitivity of 90%, specificity 100%, PPV 100% and NPV 90.9%. For SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%. For Hill-Sachs lesion; sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively. For ALPSA; sensitivity is 100%, specificity is 95%, PPV is 50% and NPV is 100% both for MDCTA and MRA. К value for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement. Conclusions: Considering availability, cost, time consumption, superior detection of bony lesions and comparable detection of soft tissue lesions; MDCTA can be used as single investigation of choice in shoulder instability pain.