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Is MRI Arthrogram a reliable investigation for Posterior Labrum tears of Shoulder?
EP34195
Poster Title: Is MRI Arthrogram a reliable investigation for Posterior Labrum tears of Shoulder?
Submitted on 22 Oct 2020
Author(s): R.Saini, S.Chinna, C Sharma, V.Jain, S.Kumar, R.Kothari, S Chau, C Fang
Affiliations: Royal Derby Hospital
Poster Views: 112
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Poster Information
Abstract: Background
The shoulder is a tremendously mobile joint but prone to dislocations. Arthroscopy is regarded as the diagnostic gold standard but usually preceded by MR Arthrography ( MRA), a less invasive means for investigating associated lesions. Assessment of posterior labrum lesions can, however, be problematic. This audit compared the set standard of MRA for posterior labrum lesions and inter-observer agreement against arthroscopic findings.
Standard
Arthroscopic findings the gold standard, target sensitivity 57% and specificity 96% is set by the Royal College of Radiologists for posterior tears.1
Methodology
Retrospective data collected from Sept 2015-Jan 2020, at Royal Derby Hospital. 12/73 cases of arthroscopic stabilization had posterior labrum tears. 13 cases (1 FP) were independently reviewed by 3 experienced MSK Radiologists.
Results
Sensitivity and specificity were 33.34% and 98.3 % respectively. There were 8 false negative (FN), 1 false positive (FP), and 4 true positives (TP). On Radiologist review, among the 8 FN cases, the consensus was tear was missed in 3. In the rest of the 5 cases, no tear was seen in 2 cases on MRA in agreement. There was no agreement in 3 FN cases, where 2 reviewers reported no lesion visible but 1 had a difference of opinion. 2 reviewers could see a lesion in FP case. Revised sensitivity was 58.3%.
Conclusion
This initial study suggests a limitation to achieve standards. The lesion may not be visible or there can be a difference of opinion even among experienced Radiologists. More data or comparison with other centres is needed.
Summary:
This audit suggests a limitation to achieve standards for MRI Arthrogram for Posterior labrum tears of shoulders set by Royal college of Radiologist . Independent review of False negative and False positive cases by 3 experienced MSK Radiologists suggest lesion may not be visible or there can be a difference of interpretation even among the experienced Radiologists. More data or comparison with other centres is needed.
References:
1. Saqib R, Harris J, Funk L. Comparison of magnetic resonance arthrography with arthroscopy for imaging of shoulder injuries: a retrospective study. Ann R Coll Surg Engl 2017; 99(4): 271 274.
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