Thomas Le Corroller MD, Presenter: Nothing to Disclose

Souad Acid, Abstract Co-Author: Nothing to Disclose

Boris Maurel, Abstract Co-Author: Nothing to Disclose

Daphne Guenoun, Abstract Co-Author: Nothing to Disclose

Richard Aswad MCHIR, , Abstract Co-Author: Nothing to Disclose

Pierre Champsaur MD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic effectiveness of multidetector CT-arthrography (MDCTA) in the preoperative planning of anterior shoulder instability, with correlation to MR-arthrography (MRA) and arthroscopy.

Forty consecutive patients were prospectively included between 1 to 4 weeks before shoulder anterior instability repair. The patients underwent a single shoulder joint injection of a 1:1 mixture of diluted gadoteridol (4mmol/L) and iopamidol (300 mg iodine/mL), followed by a MDCTA using a 16-detector unit and an MRA using a 1.5T MR-scanner. The MDCTA and MRA images were independently analysed by two musculoskeletal radiologists blinded to the arthroscopic findings that represented the reference standard.

In detecting glenoid rim fractures, MDCTA showed a sensitivity of 100%(12/12) and a specificity of 96%(27/28), whereas MRA demonstrated a sensitivity of 67%(8/12) and a specificity of 100% (28/28). In humeral head fractures diagnosis, MDCTA and MRA both exhibited a sensitivity of 100%(39/39) and a specificity of 100%(1/1). In depicting glenoid cartilage lesions, sensitivity and specificity were 77%(17/22) and 89%(16/18) for MDCTA, and 73%(16/22) and 94%(17/18) for MRA. In identifying ALPSA lesions, sensitivity and specificity were 93% (26/28) and 100% (12/12) for MDCTA, and 100%(28/28) and 92%(11/12) for MRA. For HAGL lesions, sensitivity and specificity were 100%(2/2) and 100% (38/38) for MDCTA, and 100%(2/2) and 97%(37/38) for MRA. In detecting middle glenohumeral ligament tears, sensitivity and specificity were 53%(10/19) and 90.5%(19/21) for MDCTA, and 53% (10/19) and 100% (21/21) for MRA. In detecting inferior glenohumeral ligament tears, MDCTA and MRA both exhibited a sensitivity of 75%(3/4) and a specificity of 97.2%(35/36).

MDCTA is accurate for the study of labro-ligamentous injuries, glenoid cartilage lesions, and Hill-Sachs fractures related to anterior shoulder instability. In addition, MDCTA appears superior to MRA in the detection of glenoid rim osseous lesions, that are known to be a crucial finding in the pre-operative planning. This technique may beneficially impact patient’s management by means of selecting the proper surgical treatment.

MDCTA is particularly accurate in the detection of glenoid rim osseous lesions, that are identified as potential causes of recurrence after surgery with capsular or labral-based repairs.

Le Corroller, T, Acid, S, Maurel, B, Guenoun, D, Aswad, R, Champsaur, P, Preoperative Imaging of Anterior Shoulder Instability: Diagnostic Effectiveness of Multidetector CT Arthrography and Comparison with MR-Arthrography and Arthroscopy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004669.html