Abstract
BackgroundTo evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology.Methods3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa.ResultsMeasurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively).ConclusionIn this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.
Highlights
To evaluate the diagnostic value of MR-derived computed tomography (CT)-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology
Of the 25 patients with shoulder pain included in this study, 13 patients (56.5%) showed no significant bony shoulder joint pathologies as depicted on conventional radiographs as the standard of reference
This study was able to demonstrate that the agreement of angle and distance measurements as well as morphological gradings between conventional radiographs and simulated radiographs, obtained from a MR-based 3D T1-weighted T1-weighted gradient-echo sequence (GRE) sequence, are excellent, suggesting that the MR-derived simulated radiographs may be a feasible technique for the evaluation and assessment of osseous shoulder pathologies
Summary
To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology. Shoulder pain is one of the leading reasons of musculoskeletal consultation in primary care with disorders of the rotator cuff, the glenohumeral and acromioclavicular joint representing the most frequent underlying pathologies [1]. Basic diagnostic procedures include a thorough medical history, clinical examination as well as conventional radiographs of the shoulder. In cases with uncertain findings on conventional radiographs or for further assessment of previously detected pathologies, additional computed tomography (CT) is commonly acquired for further assessment of the joint structures. The possibility to assess osseous structures adequately on MR images with the same sensitivity and specificity as with radiation-dependent techniques would be beneficial
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