Enter Your Email Address to Receive a
Copy of MedicExhange Member Demograhpics

A new study in January 2009 American Journal of Roentgenology suggest the MR Arthography is a more effective than 3-T MRI in the diagnosis of shoulder conditions.

The study was of 150 patients aged 50 and under with consecutive conventional shoulder MRI and MR arthrography examination and subsequently underwent arthroscopy. All patients had abnormal findings on both clinical examination and MR examinations. The patients were all referred from one orthopedic group and consented to undergo both MRI and MR arthrography examinations. None of the patients had undergone prior shoulder surgery. Full- or partial-thickness supraspinatus tendon tears, superior labral anterior-to-posterior (SLAP) tears, and anterior or posterior labral tears were assessed.

RESULTS. Three full-thickness and nine partial-thickness supraspinatus tendon tears, seven SLAP tears, six anterior labral tears, and two posterior labral tears were seen on MR arthrography but not on conventional MRI. All additional MR arthrography findings were confirmed at arthroscopy. On conventional MRI, sensitivities and specificities compared with arthroscopy were as follows:

	MRI		MR Arthrography
	Sensitivity %	Specificity %	Sensitivity %	Specificity %
anterior labral tear	83	100	98	100
posterior labral tear	84	100	95	100
SLAP tear	83	99	98	99
supraspinatus tendon tear	92	100	100	100
partial-thickness articular surface tear	68	100	97	100
partial-thickness bursal surface tear	84	100	84	100

MR arthrography showed a statistical improvement in sensitivity (p < 0.05) for detection of partial-thickness articular surface supraspinatus tears, anterior labral tears, and SLAP tears at 3 T.

CONCLUSION. In this series, MR arthrography showed statistically significant increased sensitivity for detection of partial-thickness articular surface supraspinatus tears, anterior labral tears, and SLAP tears compared with conventional MRI at 3 T. On the basis of the above findings, doctors should perform 3-T MR arthrography on patients for whom anterior labral tears, SLAP tears, and partial-thickness supraspinatus tendon tears are suspected clinically.

"With MR arthrography we were able to see things with a high degree of accuracy in the shoulder. Resolution and picture quality using 3T MRI is high in the shoulder, except for lesions that are hidden without distention (swelling) of the joint. During MR arthrography, the distention of the joint allowed us to uncover lesions that could not be seen on conventional MRI. The performance of MR arthrograms allows us to see additional, pertinent surgical lesions and provides a better road map for surgeons. Patients should have MR arthrography before surgery to provide an accurate diagnosis, determining whether or not they really even need surgery. If an MR arthrogram is normal, it is very likely to be normal during surgery," Thomas Magee, MD, lead author of the study.

Significance:

Suggests MR Arthrography offers strong benefits in diagnosis of  certain shoulder injuries.

Source:  http://www.ajronline.org/cgi/content/abstract/192/1/86