Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review

Abstract

Purpose: To determine the reliability and accuracy of different imaging modalities in assessing Hill-Sachs lesions within the setting of anterior shoulder instability. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, Scopus, Embase, and Cochrane Library databases. The inclusion criteria were clinical trials or cadaveric studies that assessed the accuracy of humeral head bone loss imaging or reliability and English-language articles. The exclusion criteria were animal studies; imaging studies without measures of accuracy, reliability, or clinical predictive power; studies of shoulder injuries without humeral head bone loss; editorials; abstracts; reviews; case reports; and surveys. The search terms included "imaging" OR "radiographic" OR "CT" OR "MRI" AND "Hill-Sachs" OR "humeral head bone loss." Assessment of the methodologic quality of the included studies was performed using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Results: Forty studies (2,560 shoulders) met the inclusion criteria and were assessed. For diagnosing the presence of Hill-Sachs lesions, computed tomography (CT) arthrography had the highest reported accuracy (median, 91%; range, 66%-100%). For the same assessment, CT arthrography also had the greatest reported sensitivity (median, 94%; range, 50%-100%). For the quantification of Hill-Sachs lesion parameters, reported intraobserver reliabilities were highest for 3-dimensional (3D) CT (intraclass correlation coefficient [ICC] range, 0.916-0.999), followed by 2-dimensional CT (ICC range, 0.858-0.861) and magnetic resonance imaging (MRI) (ICC range, 0.28-0.97). For the same quantification parameters, interobserver reliabilities were also reported for 3D CT (ICC range, 0.772-0.996), 2-dimensional CT (ICC range, 0.721-0.879), and MRI (k range, 0.444-0.700). Intraobserver reliabilities for determining glenoid tracking were only reported for 3D CT (k range, 0.730-1.00; ICC range, 0.803-0.901) and MRI (ICC range, 0.770-0.790). Conclusions: This study shows that the current literature supports a variety of different imaging modalities that provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, as well as determining whether they will cause persistent anterior shoulder instability. Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm on the proper imaging modalities needed to help treat patients with anterior shoulder instability that is both reliable and financially acceptable. Level of Evidence: Level IV, systematic review of Level I through IV studies.

Accurate Assessment of the Hill-Sachs Lesion: There Is No Information About the Accuracy of Quantification of These Lesions

“…2 However, we have recently shown that 3D imaging is superior to 2-dimensional imaging. 3,4 Thus, we agree with Verweij et al that 3D imaging is likely the "gold standard" in diagnosing, quantifying, and determining whether a HilleSachs lesion is truly "on" or "off" track. 2 Lastly, although we believe that 3D computed tomography is the most reliable way to quantify these lesions, 3D magnetic resonance imaging has the potential to provide similar accurate information while decreasing cost and radiation exposure to the patient.…”

“…Measuring bony lesions can be difficult, as has recently been shown for measurement of bony Bankart lesions. 6 Vopat et al 4 discuss that the literature confirms 3D-CT as the gold standard in quantifying humeral bone loss, which is shown to be the case for identifying these lesions. However, a gold standard for quantifying lesions should consist of a modality (such as 3D-CT) in combination with a measuring method.…”

“…5 Hence, Cicak et al did measure volume but did not determine accuracy for their measuring method. This may also be the reason Vopat et al 4 found possible bias in the reference standard with the QUADAS-2 tool for the study. Therefore, none of the studies seem to report accuracy for quantification of Hill-Sachs lesions, and we believe the conclusion stating that different imaging modalities show acceptable accuracy in quantifying Hill-Sachs lesions cannot be drawn.…”

“…1 A Hill-Sachs lesion is present in >84% of patients after a first-time dislocation and >88% after recurrent dislocations. 2,3 Therefore, we read "Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review" by Vopat et al 4 with great interest. The authors conclude that the studies in the review demonstrate acceptable accuracy with regard to both diagnosing and quantifying Hill-Sachs lesions.…”

Author Reply to “Accurate Assessment of the Hill-Sachs Lesion: There Is No Information About the Accuracy of Quantification of These Lesions”

“…2 Lastly, although we believe that 3D computed tomography is the most reliable way to quantify these lesions, 3D magnetic resonance imaging has the potential to provide similar accurate information while decreasing cost and radiation exposure to the patient. 5,6 Future studies are still necessary to fully establish 3D magnetic resonance imaging as a viable assessment tool.…”