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Shoulder Arthroscopy Based on MR Arthrography Findings – Are We Making the Correct Imaging Diagnosis?
EP22274
Poster Title: Shoulder Arthroscopy Based on MR Arthrography Findings – Are We Making the Correct Imaging Diagnosis?
Submitted on 23 Sep 2014
Author(s): K Rajesparan, L Firmin, C House, P DeVilliers, M Hall-Craggs
Affiliations: University College London Hospital
This poster was presented at BIR Annual Congress
Poster Views: 1,616
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Poster Information
Abstract: Purpose:
To assess the accuracy of shoulder MR arthrography (MRA) detected lesions in patients undergoing subsequent arthroscopy.

Methods:
Retrospective study of 100 consecutive MRAs performed at our institute. Patient demographics, date of examination, laterality, and MRA report were obtained. In those that proceeded to arthroscopy, operative findings were compared to MRA findings for pathology with respect to the labrum, rotator cuff, bone or ligaments.

Results:
100 consecutive MR shoulder arthrograms were performed between 13/5/2013 and 27/01/2014. Of these 38 patients were planned for subsequent arthroscopy. At the time of the study 31 patients had completed arthroscopy.

Following arthroscopy, concordance between MRA findings was found in 71%, 100%, 91% and 50% with respect to labrum, rotator cuff, bone and ligament pathology respectively.

Discordance in labral lesions was due to false negatives of anteroinferior labral lesions, and false positives due to normal variants of the superior labrum. Retrospective analysis of images correctly identified arthroscopic findings in only 2 of these cases.

Discordance in ligament pathology was related to underdiagnosed inferior capsule laxity.

Summary:
Concordance between MRA and arthroscopy in identification of labral, rotator cuff, bone and ligamentous pathology is comparable with that published in the literature. Detection of labral lesions may be improved by routine use of the ABER position. This study supports opinion that MRA is inadequate at evaluating capsuloligamentous laxity.
Summary: The concordance demonstrated in this study between MRA and arthroscopy with respect to labral, rotator cuff, bone and capsuloligamentous lesions is in keeping with published data.
Concordance of labral lesions may be improved by careful attention to normal variants and routine use of the ABER view. However a proportion of arthroscopically diagnosed normal variants of the superior labrum cannot be distinguished from tears on MRA.
References: 1. Pavic R, Margetic P, Bensic M, Brnadic RL. Diagnostic value of US, MR and MR arthrography in shoulder instability. Injury. 2013 Sep;44 Suppl 3:S26-32.
2. Genovese E1, Spanò E, Castagna A, Leonardi A, Angeretti MG, Callegari L, Fugazzola C. MR-arthrography in superior instability of the shoulder: correlation with arthroscopy. Radiol Med. 2013 Sep;118(6):1022-33.
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