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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 5, pp 699–709 | Cite as

Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis

  • Adil Ajuied
  • Ciaran P. McGarvey
  • Ziad Harb
  • Christian C. Smith
  • Russell P. Houghton
  • Steven A. Corbett
Arthroscopy and Sports Medicine

Abstract

Background

Various protocols exist for magnetic resonance arthrogram (MRA) of the shoulder, including 3D isotropic scanning and positioning in neutral (2D neutral MRA), or abduction-external-rotation (ABER).

Hypothesis

MRA does not improve diagnostic accuracy for labral tears when compared to magnetic resonance imaging (MRI) performed using 3-Tesla (3T) magnets.

Method

Systematic review of the Cochrane, MEDLINE, and PubMed databases according to PRISMA guidelines. Included studies compared 3T MRI or 3T MRA (index tests) to arthroscopic findings (reference test). Methodological appraisal performed using QUADAS-2. Pooled sensitivity and specificity were calculated.

Results

Ten studies including 929 patients were included. Index test bias and applicability were a concern in the majority of studies. The use of arthroscopy as the reference test raised concern of verification bias in all studies. For anterior labral lesions, 3T MRI was less sensitive (0.83 vs. 0.87 p = 0.083) than 3T 2D neutral MRA. Compared to 3T 2D neutral MRA, both 3T 3D Isotropic MRA and 3T ABER MRA significantly improved sensitivity (0.87 vs. 0.95 vs. 0.94). For SLAP lesions, 3T 2D neutral MRA was of similar sensitivity to 3T MRI (0.84 vs. 0.83, p = 0.575), but less specific (0.99 vs. 0.92 p < 0.0001). For posterior labral lesions, 3T 2D neutral MRA had greater sensitivity than 3T 3D Isotropic MRA and 3T MRI (0.90 vs. 0.83 vs. 0.83).

Conclusions

At 3-T, MRA improved sensitivity for diagnosis of anterior and posterior labral lesions, but reduced specificity in diagnosis of SLAP tears. 3T MRA with ABER positioning further improved sensitivity in diagnosis of anterior labral tears.

Level of evidence

IV.

Keywords

3-Tesla MRI MRA Labrum Accuracy Diagnosis 

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Kaplan PA, Dussault R, Helms CA et al (2001) Shoulder. In: Kaplan PA (ed) Musculoskeletal MRI. Saunders, Philadelphia, pp 175–223Google Scholar
  2. 2.
    Magee T, Williams D, Mani N (2004) Shoulder MR arthrography: which patient group benefits most? AJR 183:969–974CrossRefPubMedGoogle Scholar
  3. 3.
    Cvitanic O, Tirman PF, Feller JF, Bost FW, Minter J, Carroll KW (1997) Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. AJR 169(3):837–844CrossRefPubMedGoogle Scholar
  4. 4.
    Kwak SM, Brown RR, Trudell D, Resnick D (1998) Glenohumeral joint: comparison of shoulder positions at MR arthrography. Radiology 208(2):375–380CrossRefPubMedGoogle Scholar
  5. 5.
    Choi JA, Suh SI, Kim BH (2001) Comparison between conventional MR arthrography and abduction and external rotation MR arthrography in revealing tears of the antero-inferior glenoid labrum. Korean J Radiol 2(4):216–221CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wintzell G, Larsson H, Larsson S, Indirect MR (1998) arthrography of anterior shoulder instability in the ABER and the apprehension test positions a prospective comparative study of two different shoulder positions during MRI using intravenous gadodiamide contrast for enhancement of the joint fluid. Skelet Radiol 27(9):488–494CrossRefGoogle Scholar
  7. 7.
    Schreinemachers SA, van der Hulst VP, Jaap Willems W, Bipat S, van der Woude HJ (2009) Is a single direct MR arthrography series in ABER position as accurate in detecting anteroinferior labroligamentous lesions as conventional MR arthrography? Skelet Radiol 38(7):675–683.  https://doi.org/10.1007/s00256-009-0692-z CrossRefGoogle Scholar
  8. 8.
    Magee T (2007) Can isotropic fast gradient echo imaging be substituted for conventional T1 weighted sequences in shoulder MR arthrography at 3 Tesla? J Magn Reson Imaging 26:118–122.  https://doi.org/10.1002/jmri.21000 CrossRefPubMedGoogle Scholar
  9. 9.
    Lee MJ, Motamedi K, Chow K, Seeger LL (2008) Gradient recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum. Skelet Radiol 37:19–25.  https://doi.org/10.1007/s00256-007-0398-z CrossRefGoogle Scholar
  10. 10.
    Dietrich TJ, Zanetti M, Saupe N, Pfirrmann CW, Fucentese SF, Hodler J (2010) Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography. Skelet Radiol 39:473–480.  https://doi.org/10.1007/s00256-009-0844-1 CrossRefGoogle Scholar
  11. 11.
    Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR 183:343–351.  https://doi.org/10.2214/ajr.183.2.1830343 CrossRefPubMedGoogle Scholar
  12. 12.
    Smith TO, Drew BT, Andoni P, Toms A (2012) A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury. Arch Orthop Trauma Surg 132:905–919.  https://doi.org/10.1007/s00402-012-1493-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA., Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535.  https://doi.org/10.1136/bmj.b2535 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al (2011) QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536.  https://doi.org/10.7326/0003-4819-155-8-201110180-00009 CrossRefPubMedGoogle Scholar
  15. 15.
    Rosman AS, Korsten MA (2007) Application of summary receiver operating characteristics (SROC) analysis to diagnostic clinical testing. Adv Med Sci 52:76–82PubMedGoogle Scholar
  16. 16.
    Choo HJ, Lee SJ, Kim OH, Seo SS, Kim JH. Comparison of three-dimensional isotropic T1-weighted fast spin-echo MR arthrography with two-dimensional MR arthrography of the shoulder. Radiology 2012; 262(3):921 – 31.  https://doi.org/10.1148/radiol.11111261
  17. 17.
    Jung JY, Jee WH, Park MY, Lee SY, Kim YS (2013) SLAP Tears: Diagnosis Using 3-T MR arthrography with the 3D Isotropic Turbo Spin Echo Sequence versus Conventional 2D Sequences. Eur Radiol 23:487–495.  https://doi.org/10.1007/s00330-012-2599-7 CrossRefPubMedGoogle Scholar
  18. 18.
    Jung JY, Yoon YC, Choi SH, Kwon JW, Yoo J, Choe BK (2009) Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology 250(2):498–505.  https://doi.org/10.1148/radiol.2493071548 CrossRefPubMedGoogle Scholar
  19. 19.
    Jung JY, Yoon YC, Yi SK, Yoo J, Choe BK (2009) Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder. Skelet Radiol 38(7):659–667.  https://doi.org/10.1007/s00256-009-0660-7 CrossRefGoogle Scholar
  20. 20.
    Magee T (2009) 3-T MRI of the Shoulder: Is MR Arthrography Necessary? AJR 192:86–92.  https://doi.org/10.2214/AJR.08.1097 CrossRefPubMedGoogle Scholar
  21. 21.
    Magee TH, Williams D (2006) Sensitivity and specificity in detection of labral tears With 3.0T MRI of the shoulder. AJR 187:1448–1442.  https://doi.org/10.2214/AJR.05.0338 CrossRefPubMedGoogle Scholar
  22. 22.
    Major NM, Browne J, Domzalski T, Cothran R, Helms C (2011) Evaluation of the Glenoid Labrum With 3-T MRI: Is Intraarticular Contrast Necessary. AJR 196:1139–1144.  https://doi.org/10.2214/AJR.08.1734 CrossRefPubMedGoogle Scholar
  23. 23.
    Modi CS, Karthikeyan S, Marks A, Saithna A, Smith CD, Rai SB et al (2013) Accuracy of abduction-external rotation MRA versus standard MRA in the diagnosis of intra-articular shoulder pathology. Orthopedics 36(3):e337–e342.  https://doi.org/10.3928/01477447-20130222-23 CrossRefPubMedGoogle Scholar
  24. 24.
    Oh DK, Yoon YC, Kwon JW, Choi SH, Jung JY, Bae S et al. Comparison of indirect isotropic MR arthrography and conventional MR arthrography of labral lesions and rotator cuff tears: a prospective study. AJR 2009; 192:473–479.  https://doi.org/10.2214/AJR.08.1223
  25. 25.
    Tian CY, Cui CJ, Zheng ZZ, Ren AH (2013) The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 82(4):651–657.  https://doi.org/10.1016/j.ejrad.2012.11.038 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Adil Ajuied
    • 1
    • 3
  • Ciaran P. McGarvey
    • 1
  • Ziad Harb
    • 1
  • Christian C. Smith
    • 1
  • Russell P. Houghton
    • 2
  • Steven A. Corbett
    • 1
    • 3
  1. 1.Department of Trauma and OrthopaedicsGuy’s and St Thomas’ Hospital NHS Foundation TrustLondonUK
  2. 2.Department of RadiologyGuy’s and St Thomas’ Hospital NHS Foundation TrustLondonUK
  3. 3.Fortius ClinicLondonUK

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