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Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis

  • Musculoskeletal
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Abstract

Objectives

We aimed to compare the reliability and performance of MRI measures enhanced with intravenous (IV) injection of gadolinium contrast versus non-enhanced MRI measures for the diagnosis of adhesive capsulitis (AC). We also aimed to examine the association between MRI findings and clinical features in patients with AC.

Methods

MRI of 42 patients with a clinical diagnosis of AC confirmed by arthrography and that of 42 patients in a control group were retrospectively studied by 2 blinded readers. Reliability and performance of MRI findings were compared between IV contrast-enhanced measures and non-enhanced MRI measures in T2-weighted fat-saturated and T1-weighted images. MRI findings were correlated with clinical stage, etiology, and pain.

Results

Sensitivity (97.6%) and specificity (97.6%) of axillary-recess capsule signal enhancement for AC diagnosis were significantly superior (p = 0.02) to hyperintense signals on T2-weighted fat-suppressed images (sensitivity 90.5%, specificity 92.7%). Measures of the intensity signal in the area of the rotator interval were less performant for AC diagnosis but could be improved with joint capsule enhancement. Moreover, we found very high specificity (100%) of enhancement of the coracohumeral ligament signal for AC diagnosis. The early stage of adhesive capsulitis was positively correlated with joint capsule enhancement in the rotator interval. Secondary etiology of capsulitis was correlated with joint capsule hyperintensity signals of the rotator interval on T2-weighted fat-suppressed images.

Conclusion

IV contrast injection with MRI can be helpful for AC diagnosis in difficult cases. The stage of AC seems related to joint capsule enhancement in the rotator interval.

Key Points

• IV gadolinium-enhanced MRI can improve the analysis of signal changes in the shoulder synovium and capsule of the shoulder that are related to adhesive capsulitis.

• As an original finding, we observed that coracohumeral ligament enhancement had a 100% specificity for the diagnosis of adhesive capsulitis.

• The intensity of enhanced signals in the rotator interval seems to be related to the early stage of frozen shoulder.

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Abbreviations

AC:

Adhesive capsulitis

AR:

Axillary recess

AUC:

Area under the ROC curve

CHL:

Coracohumeral ligament

FSE:

Fast spin echo

IV:

Intravenous

MRI:

Magnetic resonance imaging

RI:

Rotator interval

ROC:

Receiver operating characteristic

VAS:

Visual analog scale

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Service de Radiologie B, Groupe Hospitalier Cochin, AP-HP.Centre, Université de Paris, 75014, Paris, France

    Eric Pessis, Fadila Mihoubi, Antoine Feydy, Raphaël Campagna, Henri Guerini & Jean-Luc Drapé

  2. Université de Paris, Faculté de Santé, UFR Médecine Paris Descartes, Sorbonne Paris Cité, Paris, France

    Eric Pessis, Fadila Mihoubi, Antoine Feydy, Raphaël Campagna, Henri Guerini & Jean-Luc Drapé

  3. Service de Radiologie, Centre Imagerie du Nord, Clinique du Landy, 23 Rue du Landy, 93400, Saint-Ouen, France

    Eric Pessis

  4. Ecamo Team, INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité 13 (CRESS), 75006, Paris, France

    Antoine Feydy, Alexandra Roren & Marie-Martine Lefèvre-Colau

  5. Service de Rééducation et de Réadaptation de l’appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France

    Alexandra Roren, François Rannou & Marie-Martine Lefèvre-Colau

  6. INSERM UMRS 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire, UFR Sciences Fondamentales et Biomédicales, Centre Universitaire des Saints-Pères, 75006, Paris, France

    François Rannou

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  1. Eric Pessis
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Corresponding author

Correspondence to Eric Pessis.

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The scientific guarantor of this publication is Pessis E.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional review board approval was not required because participants’ data were retrospectively collected for the purpose of the present study, and formal approval by an institutional review board was not required according to the Jardé Law of March 5, 2012, and its application decree (No. 2016-1537) relating to research involving the human person in France.

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Pessis, E., Mihoubi, F., Feydy, A. et al. Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis. Eur Radiol 30, 5981–5991 (2020). https://doi.org/10.1007/s00330-020-07003-4

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  • DOI: https://doi.org/10.1007/s00330-020-07003-4

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