Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players

Abstract

Purpose To evaluate a combined imaging approach with both ultrasonography (US; conventional US and valgus stress US) and magnetic resonance (MR) arthrography in baseball players with medial elbow pain. Materials and Methods Institutional review board approval was obtained and the requirement for informed consent was waived. The study is compliant with HIPAA. Baseball players with medial elbow pain underwent US in addition to MR arthrography. Findings were assessed with each modality alone and both combined in this retrospective investigation. For the evaluation of ulnar collateral ligament (UCL) tears with stress US, the interval gapping of the medial elbow joint was measured between rest and valgus stress both at the injured and at the uninjured (contralateral) elbow. Surgical or arthroscopic correlation was available as the so-called gold standard. McNemar tests compared the accuracies of the imaging modalities. Results In this study, 144 baseball players had 191 findings of medial elbow pain, including 53 UCL tears. With stress US, joint gapping at the injured elbow greater than 1.0 mm compared with the contralateral elbow yielded a sensitivity, specificity, and accuracy of 96%, 81%, and 87%, respectively, for diagnosing UCL tears. With MR arthrography, the sensitivity, specificity, and accuracy for UCL tears were 81%, 91%, and 88%, respectively, and increased to 96% (P = .013, McNemar test), 99% (P = .023), and 98% (P < .001), respectively, when combined with US to a dual modality MR and US approach. For 31 patients with ulnar neuritis, the sensitivity, specificity, and accuracy increased from 74%, 92%, and 88%, respectively, with MR arthrography alone to 90% (P = .07, McNemar test), 100% (P < .001), and 98% (P < .001) combined with US. For the 59 myotendinous and the 48 osteochondral diagnoses, the sensitivity, specificity, and accuracy with MR arthrography alone were 93%, 93%, and 93%, and 94%, 98%, and 97%, respectively, with no additional diagnostic value from US. Conclusion The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain. (©) RSNA, 2016.

Utilizing Ultrasound Imaging to Evaluate Acute Doppler Flow Adaptions of the Medial Elbow

“…Ciccotti et al 2 indicated that the use of stress US can detect changes to the UCL in asymptomatic professional baseball pitchers. More recently Roedle et al 5 concluded that that conventional US is as accurate as MR arthrography in diagnosing UCL tears. An emerging feature of MSKUI is Power Doppler imaging quantification (PDIQ) that can be used to quantify circulation in MSK tissues and provide a measure of tissue perfusion and/or inflammation.…”

Sports Injuries about the Hip: What the Radiologist Should Know

“…In cases not responding to these treatments, surgical release of the tendons can be performed (121). A recent study has shown that the combination of MR arthrography and US is highly accurate for assessment of elbow pain in athletes (122). Similarly, we believe that US and MR arthrography are complementary for evaluation and image-guided treatment of hip disease.…”

Ultrasonography: Sports Injuries

“…The ulnar collateral ligament is evaluated dynamically with ultrasound and complements MR arthrography where the accuracy in diagnosis of tear is highest when both imaging methods are used [20]. With the elbow flexed at least 30°, valgus stress is placed across the elbow.…”

“…With the elbow flexed at least 30°, valgus stress is placed across the elbow. Asymmetric widening of the medial joint space between the humerus and ulna with valgus stress can indicate ligament tear [20]. The ulnar nerve can also be imaged by dynamic ultrasound to assess for injury or subluxation.…”