Abstract
BackgroundThe purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well-assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology.Materials and methodsWe enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa—before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radiologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images.ResultsThese images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings.ConclusionsAlthough in our pilot study the VA findings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images.
Highlights
MR arthrography (MR-AR) is considered the goldstandard of radiology in the evaluation of shoulder instability.In patients with such a condition, MR-AR allows an accurate assessment of: capsulolabral complex, undersurface of the rotator cuff (RC), glenohumeral ligaments and RC interval [1]; the technique gives information on eventual glenoid and humeral bone loss, for which computed tomography (CT) is the standard of reference.The rationale of this technique is the capsular distention
virtual arthroscopy (VA) and MR arthrographic images were fairly concordant with intraoperative findings
In all 35 cases, in the VA images, we were able to recognize the six anatomical districts, with a resulting mean quality of visualization of ‘‘optimal’’ for glenoid, humeral head and capsule sites for both radiologists; and good to optimal for the labrum, discrete to good for the ligaments, and poor to discrete for the RC undersurface for the first and second readers, respectively(Table 2)
Summary
MR arthrography (MR-AR) is considered the goldstandard of radiology in the evaluation of shoulder instability In patients with such a condition, MR-AR allows an accurate assessment of: capsulolabral complex, undersurface of the rotator cuff (RC), glenohumeral ligaments and RC interval [1]; the technique gives information on eventual glenoid and humeral bone loss, for which computed tomography (CT) is the standard of reference. The rationale of this technique is the capsular distention. On a semiquantitative scale, the visibility of the principal anatomic structures, and in consensus, the pathology emerging from the VA images
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