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Diagnosis of shoulder instability via cine MRI
$32
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67
J. Shoulder Elbow Surg. March/April 1996
Abstracts
MRI FINDINGS IN ANTERIOR GLENOHUMERAL SUBLUXATION AND DISLOCATION. S.A. Petersen, MD, A. Jahnke, MD, & C. Neumann, MD, Department of Orthopaedic Surgery, Wayne State Univ., Detroit, MI. While the diagnosis of occult instability of the glenohumeral joint remains a diagnostic challenge, MRI offers a non-invasive method to identify intra-articular pathology associated with instability. In a study designed to assess the ability of MRI to diagnose anterior glenohumerat instability, MRI scans of 40 consecutive patients, (mean age, 26 years) with a surgically confirmed diagnosis of recurrent anterior subluxation (13 patients) or dislocation (27 patients), were compared to an age-matched control group of 30 asymptomatic volunteers (mean age 26.2 years). Shoulder MRI was performed on 1.5 T magnet utilizing a specialized shoulder coil. Intra-articular pathology was confirmed by arthroscopy (33) or during shoulder reconstruction (7). Statistical analysis comparing labral, capsular and humeral morphology within each group was performed by Marasciulos' method of multiple comparisons. Anterior labral fragmentation, increased anterior labral signal, and cystic changes involving the postero-lateral humeral head were MRI findings diagnostic of anterior subluxation, (p.<0.O5). Anterior dislocation was diagnosed by fragmentation or detachment of the anterior labrum, anterior glenoid rim flattening and Hill Sach lesions of the humeral head, (p.
68
THE REPRODUCAB1LITY OF THE BIGL1AN] CLASSIFICATION SYSTEM. AN ASSESMENT OF INTEROBSERVER RELIABILITY AND INTRAOBSERVER REPRODUCABILITY USING MRI AND RADIOGRAPHY. R. de Ridderl. W.J. Willemsl, PR. Algra2, JH. Barcntszl, R.A. Manoliu2. l Dept. Orthopaedics, 2Dept. Radiology, Medisch Ccntrum Alkmaar
69
In diagnosis of impingement svndrome the roentgen supraspinatus outlet view (RSOV) is oRen used because of the assumed correlation bet~veen acromial shape and rotator cuffpathology.The shape of the acromion on the RSOV is classified according to Bigliani. Recently the shape of the acromion is also classified on the sagittal oblique MRI of the shoulder. The authors studied the interobserver reliability and intraobserver reproducability of the classification of the acromion on the RSOV and MRI. Furthermore, correlation beP,,men classifications of the acromion, using MRI and Radiography was assessed. From 38 patients (l 6 men, 22 women; ages 13-74 ) with shoulder pain 5 l RSOV's (13 both shoulders ) and 28 MRI's were obtained. Acromion shape was classified as fiat ( type I ), smoothly curved (~,pe II) or booked (type IlI) by txvo orthopaedic surgeons and two radiologists who all had a special interest in problems of the shoulder.The radiographs were reviewed without access to initial interpretation sixteen weeks later. 51 times ( 50% ) 3 out of 4 observers agreed, 22 times ( 22% ) all agreed on both viewings of the 51 RSOV's. 24 times ( 43% ) 3 out of 4 observers agreed, 16 times ( 29% ) all agreed on both viewings of the 28 MRrs. In 64.7% of RSOV's and in 72.3% of MRI's the observers scored equal in the first and last interpretation session .In 22 shoulders MRI and RSOV was available.In only 52.8% of these shoulders classification of MRI and RSOV was equal. Intraobserver reproducability and even more interobserver reliability using MRI and RSOV is low, classification on MRI is not equal to the classification on RSOV, clinical use of both techniques doubtful.
THE VALUE OF IMAGING PROCEDURES ~N THE DIAGNOSIS OF R O T A T O R C U F F TEARS. T. Schneider, J.M. Strauss, M. Glombitza, B. Fink, W. R ~ t h e r U n i v e r s i t y of Duesseldorf, Orthop. Dept., G e r m a n y
D i f f e r e n t imaging p r o c e d u r e s are in u s e for d i a g n o sis of r o t a t o r cuff tears. There is a need for evaluating d i f f e r e n t m e t h o d s such as x-ray, sonography, arthrography, MRI and CT. Material and Methods: This p r o s p e c t i v e study deals with 38 p a t i e n t s with full-thickness rotator cuff tears. D i a g n o s i s was c o n f i r m e d by o p e n surgery. T h e presurgical diagnostic schedule i n c l u d e d all of the i m a g i n g p r o c e d u r e s m e n t i o n e d above. C l i n i c a l l y and son o g r a p h i c a l l y all p a t i e n t s w e r e e x a m i n e d by the s a m e surgeon. Arthrography, MRI and C T w e r e e v a l u a t e d by at least two d i f f e r e n t examiners that are e x p e r i e n c e d in this field. The results of i m a g i n g p r o c e d u r e s were correlated to the intraoperative finding of full t h i c k n e s s tears. R e s u l t s : In 7 1 . 5 % of c a s e s the x - r a y s r e v e a l e d in any shifting of the humeral head. S e n s i t i v i t y of arthrography, a r t h r o g r a p h i c CT, s o n o g r a p h y a n d M R I w a s 60, 75, 86,5 a n d 91% respectively. Conclusions: T h e p l a n e x - r a y o n l y gives a few information r e g a r d i n g rotator cuff tears. Even by arthrograp h y and a r t h r o g r a p h i c CT 1/4 to 1/3 of t e a r s r e m a i n u n d e t e c t e d . M R I seems to be the m o s t s e n s i t i v e procedure in d i a g n o s i n g cuff tears. M R I g i v e s additional i n f o r m a t i o n on the mass and c o n f i g u r a t i o n of the sup r a s p i n a t u s m u s c l e . T h e s o n o g r a p h y in our hands p r o o v e d to be of high p r e d i c t i v e value. W i t h the additional a d v a n t a g e of a dynamic examination, s o n o g r a p h y is quick, easy, repeatable, n o t invasive and cheep.
DIAGNOSIS OF SHOULDER INSTABILITY VIA CINE MRI. Peter Bonutti, M.D.*, & Richard Chesnik, M.D. *Univ. of Arkansas, Little Rock, Arkansas PURPOSE: To compare clinical exam static MRI and CINE MRI for the evaluation of shoulder instability. CONCLUSION: ClNE MRI is a reproducible technique to evaluate normal capsular attachments to the glenoid and confirms diagnosis of anterior and posterior shoulder instability. SIGNIFICANCE: Shoulder instability is primarily a clinical diagnosis. Static MRI does not appear helpful, however ClNE MRI can reproducibly confirm the diagnosis of shoulder instability. SUMMARY OF METHOD, RESULTS, AND DISCUSSION: Shoulder instability is a dynamic process with clinical exam is the primary diagnostic technique. Currently there is no accurate imaging study to access glenoid humeral instability. ClNE MRI is a new dynamic imaging technique which is obtained by using a shoulder rotating system with 10 ~ incremental rotation from maximum internal to external rotation. Images were displayed in a closed loop CINE format. 50 normal and 150 painful shoulders were studied. History and clinical exam were performed on all 150 patients and arthroscopic correlation in 75 patients. 20 patients were diagnosed with antedor and 4 patients with posterior instability and 18 of 20 with anterior stability. Key findings in anterior instability were capsular stripping, best seen in progressive internal rotation and Bankhart lesions which were best identified with progressive external rotation. Posterior instability was identified by increased internal rotation and with internal rotation the lesser tuberosity articulating against the humeral head. Normal anatomy with the middle and inferior glenoid humeral ligament as well as the labral complex were clearly seen in the CINE studies. The CINE MRI appears useful to confirm the clinical evaluation of shoulder instability. CINE MRI clearly identifies normal capsular attachments as well as Bankhart lesions, and capsular stripping and excessing rotational motion.
66
67
J. Shoulder Elbow Surg. March/April 1996
Abstracts
MRI FINDINGS IN ANTERIOR GLENOHUMERAL SUBLUXATION AND DISLOCATION. S.A. Petersen, MD, A. Jahnke, MD, & C. Neumann, MD, Department of Orthopaedic Surgery, Wayne State Univ., Detroit, MI. While the diagnosis of occult instability of the glenohumeral joint remains a diagnostic challenge, MRI offers a non-invasive method to identify intra-articular pathology associated with instability. In a study designed to assess the ability of MRI to diagnose anterior glenohumerat instability, MRI scans of 40 consecutive patients, (mean age, 26 years) with a surgically confirmed diagnosis of recurrent anterior subluxation (13 patients) or dislocation (27 patients), were compared to an age-matched control group of 30 asymptomatic volunteers (mean age 26.2 years). Shoulder MRI was performed on 1.5 T magnet utilizing a specialized shoulder coil. Intra-articular pathology was confirmed by arthroscopy (33) or during shoulder reconstruction (7). Statistical analysis comparing labral, capsular and humeral morphology within each group was performed by Marasciulos' method of multiple comparisons. Anterior labral fragmentation, increased anterior labral signal, and cystic changes involving the postero-lateral humeral head were MRI findings diagnostic of anterior subluxation, (p.<0.O5). Anterior dislocation was diagnosed by fragmentation or detachment of the anterior labrum, anterior glenoid rim flattening and Hill Sach lesions of the humeral head, (p.
68
THE REPRODUCAB1LITY OF THE BIGL1AN] CLASSIFICATION SYSTEM. AN ASSESMENT OF INTEROBSERVER RELIABILITY AND INTRAOBSERVER REPRODUCABILITY USING MRI AND RADIOGRAPHY. R. de Ridderl. W.J. Willemsl, PR. Algra2, JH. Barcntszl, R.A. Manoliu2. l Dept. Orthopaedics, 2Dept. Radiology, Medisch Ccntrum Alkmaar
69
In diagnosis of impingement svndrome the roentgen supraspinatus outlet view (RSOV) is oRen used because of the assumed correlation bet~veen acromial shape and rotator cuffpathology.The shape of the acromion on the RSOV is classified according to Bigliani. Recently the shape of the acromion is also classified on the sagittal oblique MRI of the shoulder. The authors studied the interobserver reliability and intraobserver reproducability of the classification of the acromion on the RSOV and MRI. Furthermore, correlation beP,,men classifications of the acromion, using MRI and Radiography was assessed. From 38 patients (l 6 men, 22 women; ages 13-74 ) with shoulder pain 5 l RSOV's (13 both shoulders ) and 28 MRI's were obtained. Acromion shape was classified as fiat ( type I ), smoothly curved (~,pe II) or booked (type IlI) by txvo orthopaedic surgeons and two radiologists who all had a special interest in problems of the shoulder.The radiographs were reviewed without access to initial interpretation sixteen weeks later. 51 times ( 50% ) 3 out of 4 observers agreed, 22 times ( 22% ) all agreed on both viewings of the 51 RSOV's. 24 times ( 43% ) 3 out of 4 observers agreed, 16 times ( 29% ) all agreed on both viewings of the 28 MRrs. In 64.7% of RSOV's and in 72.3% of MRI's the observers scored equal in the first and last interpretation session .In 22 shoulders MRI and RSOV was available.In only 52.8% of these shoulders classification of MRI and RSOV was equal. Intraobserver reproducability and even more interobserver reliability using MRI and RSOV is low, classification on MRI is not equal to the classification on RSOV, clinical use of both techniques doubtful.
THE VALUE OF IMAGING PROCEDURES ~N THE DIAGNOSIS OF R O T A T O R C U F F TEARS. T. Schneider, J.M. Strauss, M. Glombitza, B. Fink, W. R ~ t h e r U n i v e r s i t y of Duesseldorf, Orthop. Dept., G e r m a n y
D i f f e r e n t imaging p r o c e d u r e s are in u s e for d i a g n o sis of r o t a t o r cuff tears. There is a need for evaluating d i f f e r e n t m e t h o d s such as x-ray, sonography, arthrography, MRI and CT. Material and Methods: This p r o s p e c t i v e study deals with 38 p a t i e n t s with full-thickness rotator cuff tears. D i a g n o s i s was c o n f i r m e d by o p e n surgery. T h e presurgical diagnostic schedule i n c l u d e d all of the i m a g i n g p r o c e d u r e s m e n t i o n e d above. C l i n i c a l l y and son o g r a p h i c a l l y all p a t i e n t s w e r e e x a m i n e d by the s a m e surgeon. Arthrography, MRI and C T w e r e e v a l u a t e d by at least two d i f f e r e n t examiners that are e x p e r i e n c e d in this field. The results of i m a g i n g p r o c e d u r e s were correlated to the intraoperative finding of full t h i c k n e s s tears. R e s u l t s : In 7 1 . 5 % of c a s e s the x - r a y s r e v e a l e d in any shifting of the humeral head. S e n s i t i v i t y of arthrography, a r t h r o g r a p h i c CT, s o n o g r a p h y a n d M R I w a s 60, 75, 86,5 a n d 91% respectively. Conclusions: T h e p l a n e x - r a y o n l y gives a few information r e g a r d i n g rotator cuff tears. Even by arthrograp h y and a r t h r o g r a p h i c CT 1/4 to 1/3 of t e a r s r e m a i n u n d e t e c t e d . M R I seems to be the m o s t s e n s i t i v e procedure in d i a g n o s i n g cuff tears. M R I g i v e s additional i n f o r m a t i o n on the mass and c o n f i g u r a t i o n of the sup r a s p i n a t u s m u s c l e . T h e s o n o g r a p h y in our hands p r o o v e d to be of high p r e d i c t i v e value. W i t h the additional a d v a n t a g e of a dynamic examination, s o n o g r a p h y is quick, easy, repeatable, n o t invasive and cheep.
DIAGNOSIS OF SHOULDER INSTABILITY VIA CINE MRI. Peter Bonutti, M.D.*, & Richard Chesnik, M.D. *Univ. of Arkansas, Little Rock, Arkansas PURPOSE: To compare clinical exam static MRI and CINE MRI for the evaluation of shoulder instability. CONCLUSION: ClNE MRI is a reproducible technique to evaluate normal capsular attachments to the glenoid and confirms diagnosis of anterior and posterior shoulder instability. SIGNIFICANCE: Shoulder instability is primarily a clinical diagnosis. Static MRI does not appear helpful, however ClNE MRI can reproducibly confirm the diagnosis of shoulder instability. SUMMARY OF METHOD, RESULTS, AND DISCUSSION: Shoulder instability is a dynamic process with clinical exam is the primary diagnostic technique. Currently there is no accurate imaging study to access glenoid humeral instability. ClNE MRI is a new dynamic imaging technique which is obtained by using a shoulder rotating system with 10 ~ incremental rotation from maximum internal to external rotation. Images were displayed in a closed loop CINE format. 50 normal and 150 painful shoulders were studied. History and clinical exam were performed on all 150 patients and arthroscopic correlation in 75 patients. 20 patients were diagnosed with antedor and 4 patients with posterior instability and 18 of 20 with anterior stability. Key findings in anterior instability were capsular stripping, best seen in progressive internal rotation and Bankhart lesions which were best identified with progressive external rotation. Posterior instability was identified by increased internal rotation and with internal rotation the lesser tuberosity articulating against the humeral head. Normal anatomy with the middle and inferior glenoid humeral ligament as well as the labral complex were clearly seen in the CINE studies. The CINE MRI appears useful to confirm the clinical evaluation of shoulder instability. CINE MRI clearly identifies normal capsular attachments as well as Bankhart lesions, and capsular stripping and excessing rotational motion.