Shoulder joint: arthrographic CT and long-term follow-up, with surgical correlation.

Abstract

One hundred two computed tomographic (CT) arthrograms of the shoulder were retrospectively reviewed and compared with conventional double-contrast arthrograms from 101 patients (24 females and 77 males aged 9-70 years). One- to 4-year follow-up was obtained in 84 patients, 40 of whom underwent open-shoulder surgery or arthroscopy. Morphology of the normal portions of each labrum was categorized according to length, width, and tip shape. Correlation between morphology and age was weak, but abnormal labra were more common in younger patients. Conventional radiography was more accurate for detecting bony glenoid margin fractures, but CT was more accurate for detecting Hill-Sach fractures. CT was also more reliable than conventional arthrography in the detection of rotator cuff tears. Hence, few if any conventional radiographs are necessary between contrast material injection and CT imaging. A reduction in the number of images obtained will result in decreased radiation dose, less cost, and shorter examination time without loss of diagnostic accuracy.

Three-dimensional MRI of the glenoid labrum

“…Computed tomographic arthrography (CTA) has proven useful in demonstrating tears of the glenoid labrum complex [9,10]. Wilson et al [9] documented a 100% sensitivity and 97% specificity for identifying labral tears which were subsequently surgically confirmed.…”

“…Wilson et al [9] documented a 100% sensitivity and 97% specificity for identifying labral tears which were subsequently surgically confirmed. However, CTA is an invasive, ionizing procedure which is limited to true axial-only imaging.…”

“…However, CTA is an invasive, ionizing procedure which is limited to true axial-only imaging. Furthermore, despite the accuracy of CTA in evaluating labral injury, specific subpopulations of labral tear injuries, such as tears of the superior labrum, are not well demonstrated on CT due to their axial orientation [9][10][11]. The noninvasive, nonionizing, and multiplanar imaging capabilities of MRI make it an attractive alternative imaging modality for evaluating suspected labral pathology.…”

Current Concepts and Advances

“…The accuracy for detection of labral pathology using CT arthrography has been reported to be high (85% to 100%); however, much of the original research is decades old and our understanding of labral pathology is more sophisticated today. [15][16][17][18][19] Paralabral cysts are more difficult to see on CT than MRI because the cysts are similar in attenuation to adjacent rotator cuff musculature. Contrast from the arthrogram can fill these cysts via labral tears, but the flow of fluid is slow and the presence of contrast in a cyst is discovered by looking carefully for a wispy contrast collection outside the normal confines of the joint space.…”

CT and MR Arthrography of the Glenoid Labroligamentous Complex

“…Although some authors have reported accurate results for conventional magnetic resonance imaging (MRI) ,3,4 especially using new combinations of pulse sequences,5 other authors have reported sensitivities of only 0.44 to 0.56.6~7 However, multiple studies have shown that arthrography followed by computed tomography (CTa) [8][9][10][11] or magnetic resonance (MRA) [12][13][14][15] is very sensitive for diagnosing labral tears. The arthrographic injection separates closely adjacent structures from each other so that contrast completely bathes the labral surface, including any tears, which is a result that may not occur with an effusion.…”