One-shot MR and MDCT arthrography of shoulder lesions with arthroscopic correlation

摘要

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of sub-millimeter multiple detector CT (MDCT) technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. On this basis, the aim of this study was to compare the diagnostic efficacy of multidetector CT arthrography (MDCTA) and magnetic resonance arthrography (MRA) of the shoulder by performing MDCTA and MRA as a one-shot examination using a mixture of iodinated and paramagnetic contrast agents, with arthroscopic correlation. Materials and methods The study included 31 patients with suspected shoulder pathology who underwent both MDCT Arthrography (MDCTA) and MR Arthrography (MRA) as a one-shot examination. MDCTA and MRA were evaluated separately and jointly (MDCTA-MRA) in different blinded sessions. Each imaging study was evaluated for the presence of bony (Hill-Sachs) or labral (Bankart or superior labrum anteroposterior [SLAP] lesions), and rotator cuff disorder (full- or partial-thickness tears). All patients subsequently underwent conventional arthroscopic surgery. Detailed arthroscopic findings were reported and compared with MDCTA and MRA findings. We determined sensitivity, specificity and accuracy of both MDCTA and MRA for detecting various shoulder pathologies on the basis of the arthroscopic findings. Results Sensitivity, specificity and accuracy were comparable in each imaging study for Bankart, SLAP, Hill-Sachs lesions and full-thickness rotator cuff tears, but those of MDCTA were significantly lower than MRA for partial-thickness cuff tears. Conclusion We suggest that the sensitivity of diagnosing shoulder lesions is similar for MDCTA and MRA. MDCTA is effective for diagnosing and evaluating shoulder pathology.