Jul 30, 2008 - spective study has described the usefulness of ... arthrography for the diagnosis of labral and rotator cuff lesions on a 3-T MR unit. ... years; mean age, 47.1 years) and 20 women (age ..... 2âArthroscopically proven anterior labral lesion in 22-year-old man ... ties reported in previous studies and showed. A.
Musculoskeletal Imaging • Original Research Oh et al. Conventional Versus Isotropic MR Arthrography of the Shoulder Musculoskeletal Imaging Original Research
Comparison of Indirect Isotropic MR Arthrography and Conventional MR Arthrography of Labral Lesions and Rotator Cuff Tears: A Prospective Study Dae Kun Oh1 Young Cheol Yoon1 Jong Won Kwon1 Sang-Hee Choi1 Jee Young Jung1 Sooho Bae1 Jaechul Yoo 2 Oh DK, Yoon YC, Kwon JW, et al.
Keywords: arthrography, MR; MRI, 3D; MRI, high field strength; MRI, rapid imaging; shoulder DOI:10.2214/AJR.08.1223 Received May 12, 2008; accepted after revision July 30, 2008. 1 Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea. Address correspondence to Y. C. Yoon (ycyoon@ skku.edu). 2 Department of Orthopedic Surgery, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
AJR 2009; 192:473–479 0361–803X/09/1922–473 © American Roentgen Ray Society
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OBJECTIVE. The purpose of our study was to prospectively compare the diagnostic accuracy of 3D isotropic indirect MR arthrography with conventional sequences of indirect MR arthrography for the diagnosis of labral and rotator cuff lesions on a 3-T MR unit. SUBJECTS AND METHODS. Thirty-six consecutive patients who were scheduled for shoulder arthroscopic surgery at our institution underwent indirect MR arthrography. Both conventional sequences and an additional 3D isotropic sequence were obtained 1 day before arthroscopic surgery. Two musculoskeletal radiologists prospectively evaluated the images in consensus for the presence of superior and anterior labral lesions and subscapularis and supraspinatus–infraspinatus tendon tears using the conventional sequences and the 3D isotropic sequence. We analyzed the statistical difference between the sensitivities and specificities of both methods using arthroscopic findings as the reference standard. RESULTS. Surgical findings confirmed the presence of 23 superior labral lesions, eight anterior labral lesions, 21 subscapularis tears, and 24 supraspinatus–infraspinatus tears. The sensitivity and specificity of the conventional sequences were 74% and 54% for superior labral lesions, 88% and 96% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 75% for supraspinatus–infraspinatus tendon tears. The sensitivity and specificity of the 3D isotropic sequence were 70% and 85% for superior labral lesions, 100% and 100% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 67% for supraspinatus–infraspinatus tendon tears. No statistically significant difference was seen in sensitivities and specificities for both methods. CONCLUSION. Three-dimensional isotropic MR arthrography sequences with multiplanar reconstruction can provide a similar capability for the diagnosis of labral and rotator cuff lesions as conventional MR arthrography sequences but in a shorter imaging time.
I
n the diagnosis of disorders of the glenoid labrum and rotator cuffs, indirect and direct MR arthrography has been reported to be superior to conventional MRI, particularly for superior labral anterior to posterior (SLAP) lesions and for partial-thickness rotator cuff tears [1–5]. In addition, the recently introduced 3-T MRI systems have provided an increased signal-to-noise ratio (SNR) for use when it is feasible to achieve faster and high resolution. Faster imaging will lead to decreased motion artifacts, increased convenience of the patient, and improved and more accurate diagnosis because of increased resolution [6]. Recently, isotropic imaging that allowed saving imaging time by using a single acquisition and by obtaining diverse images
using reformation in arbitrary planes has been tested as an alternative method [7]. In retrospective studies, Magee and Williams [8, 9] reported that shoulder imaging on a 3-T system showed high accuracy for the diagnosis of supraspinatus tendon and labral lesions; and isotropic imaging using a fast gradient on a 3-T system showed labral lesions and rotator cuff lesions as well as conventional imaging in a short time [10]. To our knowledge, no prospective study has described the usefulness of isotropic imaging of the shoulder. The purpose of this study was to compare prospectively the diagnostic accuracy of 3D isotropic MR arthrography using a gradient-refocused echo (GRE) technique with conventional MR arthrography for the diagnosis of labral and rotator cuff lesions on a 3-T MR unit.
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Oh et al. Subjects and Methods Patients The institutional review board approved the study, which was conducted in compliance with HIPAA regulations. Patient informed consent was obtained. Between March 2006 and June 2006, 36 con secutive patients who were scheduled for shoulder arthroscopic surgery at our institution were en rolled in this prospective study. Arthroscopic surgery was indicated on the basis of clinical symptoms and signs and MRI findings. The study population consisted of 16 men (age range, 20–71 years; mean age, 47.1 years) and 20 women (age range, 27–77 years; mean age, 59.3 years). Six patients presented with shoulder instability and the remaining 30 patients with shoulder pain and motion limitation. Exclusion criteria were a his tory of shoulder surgery, surgery for infection or tumor, and contraindications to MRI.
MRI Protocol All MR examinations were performed 1 day before arthroscopic surgery. According to our standard protocol, 0.1 mmol/kg of gadopentetate dimeglumine (Magnevist, Bayer Schering Pharma) was injected IV, and patients were instructed to exercise for 15 minutes. After active exercise, MRI was performed with a 3-T whole-body MR scanner (Gyroscan Intera Achieva, Philips Health care) with a dedicated receive-only shoulder coil. Patients were positioned with the humerus in a neutral position and the thumb pointing upward. The following conventional MR arthrography sequences were obtained: Fat-suppressed T1weighted fast spin-echo sequences were obtained in the axial plane (TR range/TE range, 434– 565/18–24; section thickness, 3 mm; field of view, 15 cm; matrix dimensions, 224 × 224); in the coronal oblique plane parallel to the long axis of the supraspinatus tendon (434–565/20–24; section thickness, 3 mm; field of view, 15 cm; matrix, 224 × 224); and in the sagittal oblique plane perpendicular to the long axis of the supraspinatus tendon (434–561/18–24; section thickness, 4 mm; field of view, 15 cm; matrix dimensions, 256 × 256). T2-weighted fast spin-echo sequences were obtained in the axial plane (TR range/TE, 2,868– 3,184/80; section thickness, 3 mm; field of view, 15 cm; matrix dimensions, 224 × 224) and in the coronal oblique plane (2,661–2,906/80; section thickness, 3 mm; field of view, 15 cm; matrix dimensions, 224 × 224). The number of excitations for conventional MR arthrography was 2. The echo-train length of the T2-weighted fast spin-echo sequence was 16. The total scanning time for conventional MR arthrography was 16 minutes 40 seconds. Subsequently, a 3D fast GRE technique
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with fat suppression (THRIVE: T1-weighted highresolution isotropic volume examination) was performed in the axial plane to obtain additional 3D isotropic MR images using the following imaging parameters: TR/TE, 7.8/3.4; section thickness, 0.6 mm; field of view, 18 cm; matrix dimensions, 300 × 300; voxel size, 0.6 × 0.6 × 0.6 mm; sensitivity encoding (SENSE), 2; number of excitations, 2; flip angle, 7°; number of slices, 120. The total scanning time was 5 minutes 32 seconds.
Image Analysis MR images were prospectively evaluated by two musculoskeletal radiologists, one with 5 years of experience in musculoskeletal MRI and one with 2 years of experience in musculoskeletal MRI, by consensus. We analyzed labral lesions, subscapularis tendon tears, and supraspinatus– infraspinatus tendon tears. The criteria for de fining a labral lesion were as follows [11, 12]: identification of contrast material extending into a linear or complex tear cleft in the labrum; the absence of the labrum; a marked deformity of the labrum; intralabral high signal intensity reaching the articular surface of the labrum; truncation or fragmentation of the labrum; and displacement of the labrum from its expected anatomic location. These labral lesions were evaluated and were re corded as present or absent according to location. In addition, the following imaging features were used to differentiate between a SLAP type II lesion and a sublabral recess. Lateral or superior extension of contrast medium into the superior labrum and the biceps anchor indicated a SLAP type II lesion, whereas medial extension of the contrast medium with a smooth linear appearance between the superior labrum and the glenoid rim was indicative of a sublabral recess [13]. A Buford complex con sisting of an absent anterosuperior labrum and a thick cordlike middle glenohumeral ligament [14] that may be mistaken for a displaced labral fragment on arthrography was excluded [15]. Subscapularis tendon tears were defined as follows: discontinuity of the tendon, contrast medium entering the ten don, abnormal signal intensity, and caliber change. Furthermore, ancillary signs of subscapularis tendon abnormality were considered [16]. These signs included the presence of fatty infiltration in the subscapularis muscle and abnormalities in the course of the long biceps tendon. A supraspinatus– infraspinatus tear was graded as either a full-thickness tear or a partial-thickness tear. A partial-thickness tear was classified as an articular surface or bursal surface tear. The imaging criterion of a fullthickness tear was complete discontinuity in the tendon. The criteria for partial-thickness articular surface tears included focal discontinuity of the undersurface of the supraspinatus–infraspinatus
tendon. The criteria of partial-thickness bursal surface tears were abnormal signal intensity of the bursal surface of the tendon or focal disr uption of the bursal surface of the tendon [17]. Two observers evaluated labral lesions, sub scapularis tendon tears, and supraspinatus–infra spinatus tendon tears with conventional MR arthrography sequences (method A). The evalu ation was repeated after 2 weeks with the 3D isotropic MR arthrography sequence (method B). Images were presented in random order at each reading session and were evaluated using a PACS (Centricity Radiology RA 1000, GE Healthcare). The reformation in method B was performed simultaneously during image analysis using com mercially available software (Advantage Windows suite 1.0, GE Healthcare) according to oblique coronal and oblique sagittal plane images and additional images in arbitrary planes if needed.
Arthroscopic Surgery An arthroscopic finding was considered the reference standard. One orthopedic surgeon with 6 years of experience in shoulder surgery who was not blinded to the indirect MR arthrographic images performed the arthroscopic surgery. The surgeon recorded the presence or absence of a superior labral lesion, including significant de generation and fraying requiring treatment. Anter ior labral lesions, subscapularis tendon tears, and supraspinatus–infraspinatus tendon tears were re corded in the same manner.
Statistical Analysis The sensitivity, specificity, and accuracy of both method A and method B were calculated. For calculation of the sensitivity, specificity, and accuracy of supraspinatus–infraspinatus tendon tears, grades of the tear (a full- or partial-thickness tear) were not considered. Sensitivity for each type of supraspinatus–infraspinatus tendon tear as determined by both methods was also calculated. We analyzed the statistical difference of the sen sitivities, specificities, and accuracies in diagnos ing labral lesions, subscapularis tendon tears, and supraspinatus–infraspinatus tendon tears, as well as the sensitivities for each type of supraspinatus– infraspinatus tendon tear for methods A and B using the McNemar test. A p value of less than 0.05 was considered a statistically significant difference. To calculate the adequate sample size, we hypothesized that sensitivity and specificity for the diagnosis of labral and rotator cuff lesions using method B would be equal to those of method A on a 3-T MR unit. If a difference in sensitivity and specificity of method A versus method B was less than 20%, it was regarded as not meaningful. We assumed that the sensitivity of method A for the
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AJR:192, February 2009
57
64
F
10
59
67
F
F
13
14
60
M
36
22
47
43
59
50
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method A
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method B
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Surgery
Superior Labral Lesion
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method A
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method B
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Surgery
Anterior Labral Lesion
Note—SSP–ISP = supraspinatus–infraspinatus, FT = full-thickness, PT = partial-thickness.
F
M
F
32
33
35
57
M
31
34
41
F
M
30
20
46
25
F
M
27
22
M
M
26
53
29
M
25
77
43
67
49
77
56
28
F
F
22
24
F
21
23
F
F
20
M
M
18
19
50
M
17
54
F
M
15
16
62
71
F
M
11
12
57
27
F
M
57
53
8
7
72
69
69
76
62
Age (y)
9
F
M
6
F
F
4
5
F
F
2
3
M
1
Patient No. Sex
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method A
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Method B
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Tear
Surgery
Subscapularis Tendon
PT articular
PT bursal
PT articular
FT
FT
PT bursal
PT bursal
FT
FT
PT bursal
FT
PT bursal
FT
PT articular
PT articular
PT articular
FT
FT
FT
PT articular
PT articular
FT
PT bursal
FT
FT
FT
FT
Method A
PT articular
FT
FT
FT
PT bursal
FT
PT bursal
FT
PT bursal
FT
PT bursal
FT
PT articular
PT articular
PT articular
FT
FT
FT
PT bursal
PT articular
PT bursal
PT bursal
FT
FT
FT
FT
PT articular
Method B
Surgery
PT articular
PT bursal
FT
FT
FT
FT
FT
PT bursal
FT
PT bursal
FT
PT articular
PT articular
FT
FT
FT
PT articular, PT bursal
PT articular, PT bursal
PT bursal
PT articular
FT
FT
FT
FT
SSP–ISP Tendon
TABLE 1: Findings with Conventional MR Arthrography (Method A), 3D Isotropic MR Arthrography (Method B), and Arthroscopic Surgery
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Oh et al. diagnosis of rotator cuff tear was 80%. An α error level or confidence level of 5% and a β error level or statistical power (1 – β) of 80% were used. The calculated sample size was 36 (SPSS, version 12).
Results Patient data and results are summarized in Table 1. After arthroscopic surgery, 23 patients were identified as having superior labral lesions, eight as having anterior labral lesions, 21 as having subscapularis tendon tears, and 24 as having supraspinatus–infraspinatus tendon tears. Among supraspinatus–infraspinatus tendon tears, there were 14 full-thickness tears in 14 patients, six articular surface partial-thickness tears in six patients, and six bursa surface partial-thickness tears in six patients. Two patients had both articular and bursal surface partial-thickness tears simultaneously. Seventeen of 23 patients with superior labral lesions were correctly diagnosed using method A and 16 patients using method B (Fig. 1). Superior labral lesions in two patients were missed using method A only, and lesions in another three patients were missed using method B only. Superior labral lesions in four patients were missed using both methods A and B, and a patient with no superior labral lesion detected at arthroscopy was misdiagnosed as having a superior labral lesion using both methods. Seven of eight patients with anterior labral lesions were correctly diagnosed using method A, and all eight patients were correctly diagnosed using method B (Fig. 2). One false-positive diagnosis each and one false-negative diagnosis each were generated using only method A. Fourteen of 21 patients with subscapularis tendon tears were correctly diagnosed using methods A and B. Four false-negative diagnoses were generated using both methods (Fig. 3). Each method showed three falsepositive diagnoses. Twenty-three of 24 patients with a supraspinatus–infraspinatus tendon tear were correctly diagnosed using methods A and B (Fig. 4). One false-negative diagnosis was generated by both methods. Method A showed three false-positives, and method B, four false-positives. Among these false-positive diagnoses, two were misdiagnosed by both methods (Fig. 5). Diagnostic values of both methods for evaluating the labral abnormalities and rotator cuff tears are summarized in Table 2. No statistically significant difference was seen between the diagnostic efficacy of method A and method B for a labral lesion and rotator cuff tear.
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A
B
Fig. 1—Arthroscopically proven superior labral lesion in 53-year-old woman. A, Fat-suppressed T1-weighted oblique coronal image shows increased signal intensity between superior labrum and glenoid rim (arrow), which was interpreted as superior labral lesion. B, Three-dimensional isotropic MR arthrography sequence with oblique coronal reformatted image shows similar findings (arrow). Lesion was interpreted as superior labral lesion.
A
B
Fig. 2—Arthroscopically proven anterior labral lesion in 22-year-old man with recurrent shoulder dislocation. A, Fat-suppressed T1-weighted axial image shows contrast material extending into bony labrum (arrow), which was interpreted as anterior labral lesion. B, Axial 3D isotropic MR arthrography image again shows lesion (arrow), which was interpreted as anterior labral lesion.
For lesion-to-lesion evaluation of supraspinatus–infraspinatus tendon tears, the detection rate of both methods for a full-thickness tear was 100% (14/14). A full-thickness tear, however, was reported as a partial-thickness tear by both methods. For partial-thickness articular surface tears, the detection rates were 83% (5/6) for method A and 50% (3/6) for method B (Fig. 4). Two partial-thickness articular surface tears that coexisted with a bursal surface tear were missed by method B. In addition, one of the tears was thought to be a full-thickness tear using method A. For partial-thickness bursal surface tears, the detection rate was 83% (5/6) for method A and 100% (6/6) for method B. A partial-thickness bursal surface tear that coexisted with
an articular surface tear was missed, and another tear was regarded as a full-thickness tear by method A. Overall detection rates for supraspinatus–infraspinatus tears on a lesion-to-lesion basis were 92% with both methods. With method B, another partialthickness bursal surface tear was considered a full-thickness tear. The overall detection rates for supraspinatus–infraspinatus tendon tears were 92% (24/26) for method A and 88% (23/26) for method B. This difference was not statistically significant. Discussion Three-dimensional Fourier transformation imaging techniques using GRE sequences have been applied to various structures,
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Conventional Versus Isotropic MR Arthrography of the Shoulder
A
B
Fig. 3—Arthroscopically proven subscapularis tendon tear in 57-year-old man. A and B, Fat-suppressed T1-weighted (A) and 3D isotropic MR arthrography (B) axial images show subtle high signal intensity at articular side of cranial portion of subscapularis tendon (arrows), which was interpreted as normal subscapularis tendon.
A
B
C
D
Fig. 4—Arthroscopically proven partial-thickness articular surface tear of supraspinatus tendon in 54-year-old man. A and B, Fat-suppressed T1-weighted oblique coronal (A) and oblique sagittal (B) images show focal accumulation of contrast material and indistinct margin at articular surface of supraspinatus tendon (arrows), which was interpreted as partial-thickness articular surface tear of supraspinatus–infraspinatus tendon. C and D, Three-dimensional isotropic MR arthrography oblique coronal (C) and sagittal (D) reformatted images again show identical findings (arrows). Lesion was interpreted as partial-thickness articular surface tear of supraspinatus–infraspinatus tendon.
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including cartilage of the knee and the ligaments of the wrist and ankle. The use of these techniques has several advantages, such as high spatial resolution and the opportunity of postprocessing [18–20]. In addition, a recent study showed that a combination of higher field strength and a parallel imaging technique led to improved diagnostic ability and a reduction of scanning time in imaging of the ankle [21]. THRIVE, which was used in this study, is a T1-weighted turbo field echo 3D scan with spectral attenuated inversion recovery (SPAIR) fat suppression using sensitivity encoding (SENSE). The ability of THRIVE for isotropic voxel imaging permits multiplanar reconstruction (MPR) without loss of image conspicuity. Its T1 nature and its faster image acquisition because of its short TE (3–5 milliseconds) and TR (7–10 milliseconds) (1–2.5 seconds per slice) are other features that made THRIVE suitable for MR arthrography in this study. In this study, although no statistically significant difference was seen, the sensitivity and specificity of the 3D isotropic MR sequence for the diagnosis of anterior labral lesions and the specificity for the superior labrum were slightly higher than the sensitivity and specificity of conventional MR arth rography sequences. The sensitivity for a superior labral lesion on a 3D isotropic MR sequence was slightly less than that reported in a previous study (74–96%) [22]. The small number of enrolled patients and the delay in obtaining the 3D isotropic MR sequence after performing conventional MR arthrography may be an explanation for the difference. Sensitivities, specificities, and accuracies for diagnosing anterior labral tears, subscapularis tendon tears, and supraspinatus– infraspinatus tendon tears were comparable to those of previous investigations [5, 23] and showed no statistically significant difference between the two methods. For a lesion-to-lesion diagnosis of a supraspinatus– infraspinatus tendon tear, the sensitivity of 3D isotropic MR arthrography for a partialthickness articular surface tear was 50% (3/6), which was relatively lower than the sensitivity reported in previous studies with 3-T imaging [9] or imaging with abduction and an external rotation position [24]. The small number of tears may be responsible for this difference. The sensitivities and specificities for a full-thickness tear and a partial-thickness bursal surface tear were comparable to the sensitivities and specificities reported in previous studies and showed
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A
B
Fig. 5—Arthroscopically proven calcific tendinosis with no tear of supraspinatus tendon in 57-year-old woman. A and B, Fat-suppressed T1-weighted oblique coronal (A) and 3D isotropic MR arthrography oblique coronal reformatted (B) images show accumulation of contrast material at articular side of supraspinatus tendon (arrows), which was interpreted as articular side partial-thickness supraspinatus–infraspinatus tendon tear.
no statistically significant differences between the two methods. Although the imaging time for the 3D isotropic MR arthrography sequence was much shorter than that of conventional MR arth rography sequences, MPR required additional time. In this study, we were able to minimize the time for MPR by using a PACSembedded program that supplied the capability of simultaneous MPR. If MPR was to be performed at another console by a technician or another radiologist, the advantages of the 3D isotropic MR arthrography sequence, including timesaving and the ability to reconstruct in an arbitrary plane, would be decreased. This study has several limitations. First, patient selection bias may have been introduced and resulted in the overestimation of diagnostic performance because we enrolled in our study only patients who underwent arthroscopic shoulder surgery. Second, although arthroscopy was regarded as the reference standard for this study, it is an operator-dependent method. Thus, misinterpretation dur ing arthroscopy was a probable source of error. Third, 3D isotropic MR images were
obtained, followed by 2D conventional MR arthrography 30 minutes after IV contrast injection. This procedure might cause an underestimation of the diagnostic value of 3D isotropic MR arthrography in the diagnosis of a shoulder lesion. Fourth, we evaluated images by a consensus instead of independent reviewer observation. Thus, we were not able to obtain interobserver agreement. Finally, we did not compare the image quality of an axial source image of 3D isotropic MR arthrography and the reformatted image. In theory, however, the quality of reformatted images is comparable to that of axial source images on a 3D isotropic MR arthrography sequence because 3D isotropic MR arthrography consists of isotropic voxels. In conclusion, 3D isotropic MR arthrography with MPR is a method for the diagnosis of labral and rotator cuff lesions that is comparable to conventional MR arthrography but has a shorter imaging time. References 1. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrog-
raphy. AJR 1993; 161:1229–1235 2. Sommer T, Vahlensieck M, Wallny T, et al. Indirect MR arthrography in the diagnosis of lesions of the labrum glenoidale [in German]. Rofo 1997; 167:46–51 3. Maurer J, Rudolph J, Lorenz M, et al. A prospective study on the detection of lesions of the labrum glenoidale by indirect MR arthrography of the shoulder [in German]. Rofo 1999; 171:307–312 4. Lee JH, Van Raalte V, Malian V. Diagnosis of SLAP lesions with Grashey-view arthrography. Skeletal Radiol 2003; 32:388–395 5. Yagci B, Manisali M, Yilmaz E, et al. Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures. Eur Radiol 2001; 11:258–262 6. Gold GE, Suh B, Sawyer-Glover A, Beaulieu C. Musculoskeletal MRI at 3.0 T: initial clinical experience. AJR 2004; 183:1479–1486 7. Gold GE, Busse RF, Beehler C, et al. Isotropic MRI of the knee with 3D fast spin-echo extended echo-train acquisition (XETA): initial experience. AJR 2007; 188:1287–1293 8. Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR 2006; 187:1448–1452 9. Magee T, Williams D. 3.0-T MRI of the supraspinatus tendon. AJR 2006; 187:881–886 10. Magee T. Can isotropic fast gradient-echo imaging be substituted for conventional T1-weighted sequences in shoulder MR arthrography at 3 Tesla? J Magn Reson Imaging 2007; 26:118–122 11. Legan JM, Burkhard TK, Goff WB 2nd, et al. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology 1991; 179:241–246 12. Probyn LJ, White LM, Salonen DC, Tomlinson G, Boynton EL. Recurrent symptoms after shoulder instability repair: direct MR arthrographic assessment—correlation with second-look surgical evaluation. Radiology 2007; 245:814–823 13. Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR 2004; 182:1271–1278 14. Kwak SM, Brown RR, Resnick D, Trudell D, Applegate GR, Haghighi P. Anatomy, anatomic
TABLE 2: Diagnostic Values of Conventional MR Arthrography (Method A) and 3D Isotropic MR Arthrography (Method B) for Labral Abnormalities and Rotator Cuff Tears Superior Labrum Method
Method A Method B
Anterior Labrum p
Method A Method B
Subscapularis Tendon p
Method A Method B
SSP–ISP Tendon p
Method A Method B
p
Sensitivity
74%
70%
0.65
88%
100%
—
67%
67%
1.00
96%
96%
—
Specificity
54%
85%
0.10
96%
100%
—
85%
85%
1.00
75%
67%
0.56
Accuracy
67%
75%
0.36
94%
100%
—
75%
75%
1.00
89%
83%
0.56
Note—Dash (—) indicates p value could not be calculated. SSP–ISP = supraspinatus–infraspinatus.
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F O R YO U R I N F O R M AT I O N
The comprehensive book based on the ARRS 2008 annual meeting categorical course on State-of-the-Art Emergency and Trauma Radiology is now available! For more information or to purchase a copy, see www.arrs.org.
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