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Background: Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. Methods: Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. Results: The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the metaanalysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. Conclusion: MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

BackgroundMR arthrography (MRA) is commonly used in the assessment of shoulder internal derangements. Correct intra‐articular contrast injection is required for this modality. Anterior injections under fluoroscopic, ultrasound‐guidance, or without image‐guidance have been described in the literature. However, no simultaneous comparison has been performed between the three techniques.PurposeTo compare the accuracy and performance of fluoroscopy (FL)‐guided, ultrasound (US)‐guided and non‐image‐guided intra‐articular contrast injection via an anterior approach for performing shoulder MRA.Study TypeProspective.SubjectsTwo‐hundred and ten patients (180 men and 30 women; mean age, 33 ± 12 years; range 20–60 years) with clinically suspected shoulder pathology.Field Strength/Sequence1.5T/fat‐suppressed T1‐weighted, T2‐weighted, and 3D‐gradient‐echo images.AssessmentPatients underwent shoulder MRA after anterior intra‐articular contrast injection under FL‐ or US‐guidance or without image‐guidance. Patients were randomized among the three techniques with each group comprising 70. The techniques were compared according to the accuracy of intra‐articular needle placement, attempts success rate, pain during and 24 hours after injection, procedure times, contrast extravasation rate, joint distension, and MRA diagnostic efficacy. Pain was assessed by the visual analog scale (VAS) pain‐score.Statistical TestsPearson's chi‐squared and Kruskal–Wallis tests.ResultsFL‐ and US‐guided injections (100% accuracy) were significantly more accurate than non‐image‐guided (85.7% accuracy) (P < 0.05). US‐guidance was the least painful, with statistical differences between image‐guided and non‐image‐guided techniques regarding the first attempt success rate (95.7% and 92.8% for FL‐ and US‐guided vs. 78.6% for blinded), VAS‐score 24 hours‐post‐procedure (1.7 ± 1.7, and 1.5 ± 1.4 vs. 2.2 ± 1.4), procedure time (11.9 ± 1.6, and 7.4 ± 1.7 vs. 4.3 ± 0.76 minutes), and contrast extravasation rate (5.7%, and 8.6% vs. 30%) (all P < 0.05). Procedure time was also significantly different between FL and US‐guidance (P < 0.05).Data ConclusionImaging‐guided injections are more accurate and tolerable than non‐image‐guided and should be considered to confirm intra‐articular needle position, hence adequate capsular distension and good diagnostic quality of shoulder MRA. US guidance is a less painful, rapid, and safe alternative to the FL approach.Evidence Level: 2Technical Efficacy Stage: 5.J. MAGN. RESON. IMAGING 2021;53:481–490.