Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Comparison between Conventional MR Arthrograhphy and Abduction and External Rotation MR Arthrography in Revealing Tears of the Antero-Inferior Glenoid Labrum

  • Jung-Ah Choi (Department of Radiology, College of Medicine, Korea University Guro Hospital) ;
  • Sang-il Suh (Department of Radiology, College of Medicine, Korea University Guro Hospital) ;
  • Baek Hyun Kim (Department of Radiology, College of Medicine, Korea University Guro Hospital) ;
  • Sang Hoon Cha (Department of Radiology, College of Medicine, Korea University Guro Hospital) ;
  • Myung Gyu Kim (Department of Radiology, Sanggye Paik Hospital, Inje University) ;
  • Ki Yeol Lee (Department of Radiology, Sanggye Paik Hospital, Inje University) ;
  • Chang Hee Lee (Department of Radiology, Chung-Ju Hospital, Konkok University)
  • Received : 2001.04.16
  • Accepted : 2001.09.11
  • Published : 2001.12.31
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Abstract

Objective: To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. Materials and Methods: MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. Results: In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). Conclusion: MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.

Keywords

References

  1. Mohtadi NG. Advances in the understanding of anterior instability of the shoulder. Clin Sports Med 1991;10:863-870 https://doi.org/10.1016/S0278-5919(20)30588-3
  2. Chandnani VP, Gagliardi JA, Murnane TG, et al. Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography. Radiology 1995;196:27-32 https://doi.org/10.1148/radiology.196.1.7784579
  3. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MR imaging, MR arthrography, and CT arthrography. AJR 1993;161:1229-1235 https://doi.org/10.2214/ajr.161.6.8249731
  4. Zlatkin MB, Iannotti JP, Esterhai JL, et al. Evaluation of rotator cuff disease and glenohumeral instability with MR imaging: correlation with arthroscopy and arthrotomy in a large population of patients (abstr.). Magn Reson Imaging 1990;8(S):78
  5. Legan JM, Burkhard TK, Goff WB II, et al. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology 1991;179:241-246 https://doi.org/10.1148/radiology.179.1.2006284
  6. Gusmer PB, Potter HG, Schatz JA, et al. Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder. Radiology 1996;200:519-524 https://doi.org/10.1148/radiology.200.2.8685350
  7. Seeger LL, Gold RH, Bassett LW. Shoulder instability: evaluation with MR imaging. Radiology 1988;168:695-697 https://doi.org/10.1148/radiology.168.3.3406398
  8. Liu SH, Henry MH, Nuccion S, Shapiro MS, Dorey F. Diagnosis of glenoid labral tear: comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med 1996;24;149-154 https://doi.org/10.1177/036354659602400205
  9. Green MR, Christensen KP. Magnetic resonance imaging of the glenoid labrum in anterior instability. Am J Sports Med 1994;22:493-498 https://doi.org/10.1177/036354659402200410
  10. Imhoff A, Hodler J. Arthroscopy and MRI of the shoulder: a comparative retrospective analysis. Z Orthrop Ihre Grenzgeb 1992;13:188-196
  11. McCauley TR, Pope CF, Jokl P. Normal and abnormal glenoid labrum: assessment with multiplanar gradient-echo imaging. Radiology 1992;183:35-37 https://doi.org/10.1148/radiology.183.1.1549691
  12. Palmer WE, Brown JH, Rosenthal DI. Labral-ligamentous complex of the shoulder: evaluation with MR arthrography. Radiology 1994;190:645-651 https://doi.org/10.1148/radiology.190.3.8115604
  13. Willemsen UF, Wiedemann E, Brunner U, et al. Prospective evaluation of MR arthrography performed with high-volume intraarticular saline enhancement in patients with recurrent anterior dislocations of the shoulder. AJR 1998;170:79-84 https://doi.org/10.2214/ajr.170.1.9423604
  14. Kwak SM, Brown RR, Trudell D, Resnick D. Glenohumeral joint: comparison of shoulder positions at MR arthrography. Radiology 1998;208:375-380 https://doi.org/10.1148/radiology.208.2.9680562
  15. Cvitanic O, Tirman PFJ, Feller JF, Bost FW, Minter J, Carroll KW. Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. AJR 1997;169:837-844 https://doi.org/10.2214/ajr.169.3.9275908
  16. Tirman PFJ, Applegate GR, Flannigan BD, Stauffer AE, Crues JV III. Magnetic resonance arthrography of the shoulder. Magn Reson Imaging Clin N Am 1993;1:125-142 https://doi.org/10.1016/S1064-9689(21)00292-0
  17. Tirman PFJ, Bost FW, Steinbach LS, et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology 1994;192:851-856 https://doi.org/10.1148/radiology.192.3.8058959
  18. Kaplan PA, Bryans KC, Davick JP, Otte M, Stinson WW, Dussault RG. MR imaging of the normal shoulder: variants and pitfalls. Radiology 1992;184:519-524 https://doi.org/10.1148/radiology.184.2.1620858
  19. Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. AJR 1990;155:829-832 https://doi.org/10.2214/ajr.155.4.2119117
  20. Tirman RM, Janecki CJ, Eubanks RG, Nelson CL. Shoulder arthrography. Contemp Orthop 1970;1:26
  21. Tirman PFJ, Stauffer AE, Crues JV, Turner RM, Schobert WE, Nottage WM. Saline MR arthrography in the evaluation of glenohumeral instability. Arthroscopy 1993;9:141-146 https://doi.org/10.1016/S0749-8063(05)80403-7
  22. Palmer WE, Caslowitz PL, Chew FS. MR arthrography of the shoulder: normal intraarticular structures and common abnormalities. AJR 1995;164:141-146 https://doi.org/10.2214/ajr.164.1.7998527
  23. Palmer WE, Caslowitz PL. Anterior shoulder instability: diagnostic criteria determined from prospective analysis of 121 MR arthrograms. Radiology 1995;197:819-825 https://doi.org/10.1148/radiology.197.3.7480762