Azam Abbasi Eghbal MD, Presenter: Nothing to Disclose

Kerwin Jones, Abstract Co-Author: Nothing to Disclose

The purpose of this study is to compare the sensitivity of indirect magnetic resonance imaging arthrography (I-MRI) for detecting shoulder labral pathology in patients less than 21 years of age to direct MR arthrography replacement (D-MRI). The significance of the study is that shoulder I-MRI may be a reasonable and less invasive alternative to direct magnetic resonance arthrography in this population.

A retrospective review identified 68 cases of indirect shoulder arthrography performed over a two-year period at a single pediatric institution, 37 of which had subsequent shoulder arthroscopic findings available for review. The I-MRI reports were compared to the operative images for the presence or absence of labral pathology by an independent pediatric orthopedic surgeon. An independent pediatric radiologist on staff provided the MRI reports. Labral pathology was defined as a labral tear or fraying. All MRI images were also reviewed by a second pediatric radiologist for labral pathology without knowledge of surgical findings. Descriptive statistics were used to analyze data.

Of the 37 cases included in the study, the I-MRI reports correctly identified the presence or absence of labral pathology found during surgery in 32 cases. Compared to arthroscopic findings, the sensitivity of I-MRI for detecting labral pathology in young patients was 94%, with a positive predictive value of 90% and a 6% false negative percentage. The sensitivity for the second pediatric radiologist was 100%, with a positive predictive value of 94%, and a 0% false negative percentage.

Direct shoulder arthrography is currently as the gold standard imaging technique in the diagnosis of labral pathology. However, indirect shoulder arthrography is a less invasive alternative, which is extremely helpful in the young population. In this series, the sensitivity of I-MRI for detecting labral pathology was 94% (100% for the second reader) which is comparable to the historical range reported for D-MRI of 88-96%. It appears that I-MRI may be a reasonable and less invasive alternative to D-MRI in young patients.

Indirect shoulder arthrography is a less invasive alternative to Direct shoulder arthrography with comparable sensitivity.

Eghbal, A, Jones, K, Indirect Shoulder MRI Arthrography: A Novel Technique for Young Patients.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13011149.html