Skip to main content
SpringerLink
Log in

Glenohumeral position during CT arthrography with arthroscopic correlation: optimization of diagnostic yield

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the diagnostic yield of two acquisitions of single-contrast CT arthrography (CTA) of the shoulder in internal, neutral, or external glenohumeral rotation with arthroscopic correlation.

Materials and methods

The CT study was obtained using two acquisitions (first the humerus positioned in maximum tolerated external rotation with the arm along the body and the second with the humerus in internal rotation with the palm placed flat on the table). Two independent readers blinded to the arthroscopic results evaluated the CTA images for labral tears, glenoid bone loss/fractures, and cartilage loss. For each CTA acquisition, sensitivity and specificity for detection of the aforementioned pathology were assessed. Inter-reader agreement was quantified by weighted ĸ statistics.

Results

Sensitivity and specificity for detecting anteroinferior or posterior labral tears was highest with neutral rotation (sensitivity 91–100%, specificity 61–100%). For glenoid fracture, sensitivity (67%) was highest with external rotation and specificity (100%) was highest with internal rotation. For cartilage loss, sensitivity (64%) and specificity (89%) was highest with external rotation and neutral rotation, respectively. Neutral rotation showed high sensitivity and specificity for glenoid fractures and cartilage loss. Inter-reader agreement ranged from fair to very good.

Conclusions

Neutral glenohumeral position in shoulder CT arthrography was adequately sensitive and specific for the detection of intra-articular pathology, avoiding the use of more than one acquisition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Krøner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg. 1989;108(5):288–90.

    Article  PubMed  Google Scholar 

  2. Rhee R, Chan K, Lieu J, Kim B, Steinbach L. MR and CT arthrography of the shoulder. Semin Musculoskelet Radiol. 2012;16(1):3–14.

    Article  PubMed  Google Scholar 

  3. Resnik CS, Deutsch AL, Resnick D, et al. Arthrotomography of the shoulder. Radiographics. 1984;4(6):963–76.

    Article  Google Scholar 

  4. Singson RD, Feldman F, Bigliani L. CT arthrographic patterns in recurrent glenohumeral instability. AJR Am J Roentgenol. 1987;149(4):749–53.

    Article  CAS  PubMed  Google Scholar 

  5. Shuman WP, Kilcoyne RF, Matsen FA, Rogers JV, Mack LA. Double-contrast computed tomography of the glenoid labrum. AJR Am J Roentgenol. 1983;141(3):581–4.

    Article  CAS  PubMed  Google Scholar 

  6. Rafii M, Firooznia H, Golimbu C, Minkoff J, Bonamo J. CT arthrography of capsular structures of the shoulder. AJR Am J Roentgenol. 1986;146(2):361–7.

    Article  CAS  PubMed  Google Scholar 

  7. Haynor DR, Shuman WP. Double contrast CT arthrography of the glenoid labrum and shoulder girdle. Radiographics. 1984;4(3):411–21.

    Article  Google Scholar 

  8. Kim YJ, Choi J-A, Oh JH, Hwang SI, Hong SH, Kang HS. Superior labral anteroposterior tears: accuracy and interobserver reliability of multidetector CT arthrography for diagnosis. Radiology. 2011;260(1):207–15.

    Article  PubMed  Google Scholar 

  9. Deutsch AL, Resnick D, Mink JH, et al. Computed and conventional arthrotomography of the glenohumeral joint: normal anatomy and clinical experience. Radiology. 1984;153(3):603–9.

    Article  CAS  PubMed  Google Scholar 

  10. Waldt S, Metz S, Burkart A, et al. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol. 2005;16(2):451–8.

    Article  PubMed  Google Scholar 

  11. De Maeseneer M, Van Roy F, Lenchik L, et al. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics. 2000;20 Spec No:S67–81.

  12. Rafii M, Firooznia H, Bonamo JJ, Minkoff J, Golimbu C. Athlete shoulder injuries: CT arthrographic findings. Radiology. 1987;162(2):559–64.

    Article  CAS  PubMed  Google Scholar 

  13. Pennes DR, Jonsson K, Buckwalter K, Braunstein E, Blasier R, Wojtys E. Computed arthrotomography of the shoulder: comparison of examinations made with internal and external rotation of the humerus. AJR Am J Roentgenol. 1989;153(5):1017–9.

    Article  CAS  PubMed  Google Scholar 

  14. Coumas JM, Waite RJ, Goss TP, Ferrari DA, Kanzaria PK, Pappas AM. CT and MR evaluation of the labral capsular ligamentous complex of the shoulder. AJR Am J Roentgenol. 1992;158(3):591–7.

    Article  CAS  PubMed  Google Scholar 

  15. Chodick G, Ronckers CM, Shalev V, Ron E. Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. Isr Med Assoc J. 2007;9(8):584–7.

    PubMed  Google Scholar 

  16. Muratore CS. Pediatric abdominal CT scans: do it correctly. Better yet, don’t do it at all. J Surg Res. 2013;185(2):533–53417.

    Article  PubMed  Google Scholar 

  17. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Baysson H, Etard C, Brisse HJ, Bernier M-O. Expositions radiologiques à visée diagnostique pendant l’enfance et risque de cancer: bilan des connaissances et perspectives. Arch Pediatr. 2012;19(1):64–73.

    Article  CAS  PubMed  Google Scholar 

  19. Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251(1):175–84.

    Article  PubMed  Google Scholar 

  20. Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078–86.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Berrington de González A, Mahesh M, Kim K, et al. Projected cancer risks from computed tomographic scans performed in the united states in 2007. Arch Intern Med. 2009;169(22):2071–7.

    Article  PubMed  Google Scholar 

  22. Davis SJ, Teresi LM, Bradley WG, Ressler JA, Eto RT. Effect of arm rotation on MR imaging of the rotator cuff. Radiology. 1991;181(1):265–8.

    Article  CAS  PubMed  Google Scholar 

  23. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  24. Jim YF, Chang CY, Chang T. Shoulder computed arthrotomography: role of internal and external rotation. Zhonghua Yi Xue Za Zhi (Taipei). 1992;50(2):108–13.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6046, Boston, MA, 02114, USA

    F. Joseph Simeone, Corey M. Gill, Martin Torriani & Miriam A. Bredella

  2. Musculoskeletal Imaging, Hospital Israelita Albert Einstein, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil

    Atul K. Taneja

Authors
  1. F. Joseph Simeone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Corey M. Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atul K. Taneja
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Torriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miriam A. Bredella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Joseph Simeone.

Ethics declarations

Funding

None.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Simeone, F.J., Gill, C.M., Taneja, A.K. et al. Glenohumeral position during CT arthrography with arthroscopic correlation: optimization of diagnostic yield. Skeletal Radiol 46, 769–776 (2017). https://doi.org/10.1007/s00256-017-2613-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2613-x

Keywords

Search

Navigation