Shoulder pathologies in CrossFit: a magnetic resonance imaging study of 51 cases.

BACKGROUND: Recent scientific work shows that the most common injuries in CrossFit© occur in the shoulder joint. This paper aims to provide a review of shoulder pathologies in a young CrossFit© cohort via MRI and clinical examination. METHODS: A survey was conducted in 13 CrossFit "boxes" in Germany, in which athletes with recurrent shoulder pain could report for a clinical examination and MRI diagnostic. Fifty-one CrossFit athletes with chronic shoulder pain agreed to participate in the study and were then examined physically and by MRI. RESULTS: Fifty-one active CrossFit athletes aged 21-45 years (mean 33.7 years, 35 male and 16 female) were recruited. The most frequently detected pathologies were partial lesions of the supraspinatus tendon (N.=25; 49%) and labral lesions (N.=11; 21.6%). The findings also identified partial lesions of the subscapularis tendon (N.=9; 17.6%), pulley lesions (N.=9; 17.6%), and partial lesions of the infraspinatus muscle (N.=2; 3.9%). CONCLUSIONS: These data demonstrate the need for a specific focus on particular shoulder injuries in CrossFit. Knowledge about the type of shoulder pathologies caused by CrossFit training allows for training-specific adaptations with regard to prevention, as well as a more targeted, sport-specific therapy. This study is the first in the literature to present on structural changes in the shoulders of active CrossFit athletes.

Spectrum and patterns of shoulder pathology on MRI in symptomatic elite wheelchair basketball athletes.

BACKGROUND: Wheelchair basketball (WCB) is a popular para-sport adapted for athletes with physical disabilities. Shoulder injuries are commonly reported among WCB athletes. However, the understanding of the specific patterns and characteristics of shoulder injuries in WCB players is currently limited, and there is a lack of comprehensive literature available on this subject. OBJECTIVES: To investigate the spectrum of pathologies observed in elite wheelchair basketball (WCB) athletes referred for MRI evaluation of symptomatic injuries of the shoulder. METHODS: Retrospective review of consecutive elite WCB athletes referred for MRI evaluation of symptomatic shoulder injury. Demographic, clinical, and functional data including international wheelchair basketball federation (IWBF) classification of each athlete were collected. A total of 28 MRI studies were reviewed. Excluding MRI examinations of the same shoulder, 18 study cases were assessed for pathology of the rotator cuff (RC), labrum, long-head of biceps tendon, glenohumeral and acromioclavicular joints, and osseous lesions of the humerus or glenoid. Correlations between clinical-demographic features and MRI findings were statistically evaluated. RESULTS: Supraspinatus tears were observed in 72.2%, infraspinatus tears in 50%, and subscapularis tears in 38.9% shoulders. Articular-sided partial tears frequently involved posterior supraspinatus (88.9%) and anterior infraspinatus (100%). Labral tears were seen in 38.9%, with involvement of the posterosuperior labrum in all tears. Hill-Sachs and osseous Bankart lesions (5.6%), and anterior-inferior labral tears (11.1%), were uncommon findings. Statistically significant correlations were observed of low IWBF point class and non-ambulatory athletes with subscapularis tendinosis (p = 0.015, p = 0.001) and tearing (p = 0.050, p = 0.013), and athletes with limited trunk control with subscapularis tendinosis (p = 0.013). CONCLUSIONS: RC tears are common in elite WCB athletes with pattern of RC and labral tearing suggesting internal (superior-posterior) impingement as a contributory pathoetiologic mechanism. Non-ambulatory, low IWBF point class athletes, as well as those with limited trunk control have a statistically significant increase in subscapularis tendon pathology on MRI.

Preliminary exploration of deep learning-assisted recognition of superior labrum anterior and posterior lesions in shoulder MR arthrography.

PURPOSE: MR arthrography (MRA) is the most accurate method for preoperatively diagnosing superior labrum anterior-posterior (SLAP) lesions, but diagnostic results can vary considerably due to factors such as experience. In this study, deep learning was used to facilitate the preliminary identification of SLAP lesions and compared with radiologists of different seniority. METHODS: MRA data from 636 patients were retrospectively collected, and all patients were classified as having/not having SLAP lesions according to shoulder arthroscopy. The SLAP-Net model was built and tested on 514 patients (dataset 1) and independently tested on data from two other MRI devices (122 patients, dataset 2). Manual diagnosis was performed by three radiologists with different seniority levels and compared with SLAP-Net outputs. Model performance was evaluated by the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), etc. McNemar's test was used to compare performance among models and between radiologists' models. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 was considered statistically significant. RESULTS: SLAP-Net had AUC = 0.98 and accuracy = 0.96 for classification in dataset 1 and AUC = 0.92 and accuracy = 0.85 in dataset 2. In dataset 1, SLAP-Net had diagnostic performance similar to that of senior radiologists (p = 0.055) but higher than that of early- and mid-career radiologists (p = 0.025 and 0.011). In dataset 2, SLAP-Net had similar diagnostic performance to radiologists of all three seniority levels (p = 0.468, 0.289, and 0.495, respectively). CONCLUSIONS: Deep learning can be used to identify SLAP lesions upon initial MR arthrography examination. SLAP-Net performs comparably to senior radiologists.

Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury.

PURPOSE: To evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images. METHODS: Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS: Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82-1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7-4.9 and CS only range 3.2-3.8, P = 0.01-0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02-0.03). CONCLUSION: Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.

Single-Plane 3-Dimensional Isotropic Spin-Echo Magnetic Resonance Imaging Reconstructions of Shoulder Exhibit Superior Correlation to Surgical Findings Than 2-Dimensional Dixon Multiplanar Magnetic Resonance Imaging.

OBJECTIVE: The aim of the study is to evaluate concordance of multiplanar 2-dimensional magnetic resonance imaging (2D-MRI) versus 3D isotropic MRI for rotator cuff and labral tears with the reference standard of arthroscopic surgical findings. METHODS: It was an institutional review board-approved retrospective single-center study of consecutive preoperative patients with isotropic 3D-MRI on 3-Tesla scanners, multiplanar 2D-MRI, and shoulder arthroscopy. Scapular plane-oriented contiguous multiplanar reconstructions of 3D-images were evaluated by 2 experienced fellowship-trained musculoskeletal radiologists. Variables included the following: labral tear presence and rotator-cuff tear Ellman grade, thickness, and width. Sensitivities (Sen) and specificities (Spe) were calculated for binary variables. Mean squared errors (MSE) were calculated for ordinal variables. Lower MSE indicated higher concordance. RESULTS: Seventy-two patients (43 female) with a mean age of 50.75 ± 9.76 years were evaluated. For infraspinatus-tear presence, 3D-MRI showed higher sensitivity (0.96) and specificity (0.68) than 2D-MRI (Sen = 0.85, Spe = 0.32) ( Psen = 0.005, Pspe = 0.002). For subscapularis-tear presence, 3D-MRI showed higher sensitivity (0.94) and specificity (0.73) compared with 2D-MRI (Sen = 0.83, Spe = 0.56) ( Psen = 0.02, Pspe = 0.04). For supraspinatus-tear presence, there was no significant difference between 3D-MRI (Sen =0.96, Spe = 0.67) compared with 2D-MRI (Sen = 0.98, Spe = 0.83) ( Psen = 0.43, Pspe = 0.63). For infraspinatus-tear thickness, 3D-MRI showed lower MSE (0.35) compared with 2D-MRI MSE (0.82) ( P = 0.01). For subscapularis-tear thickness, 3D-MRI had lower MSE (0.31) compared with 2D-MRI MSE (0.51) ( P = 0.007). However, no difference noted for supraspinatus-tear thickness when comparing 3D-MRI MSE (0.39) and 2D-MRI MSE (0.51) ( P = 0.49). For labral-tear presence, 3D-MRI had a lower MSE (0.20) compared with 2D-MRI MSE (0.57) ( P < 0.001). CONCLUSIONS: Three-dimensional MRI of the shoulder is time efficient with a shorter acquisition time and exhibits comparable with superior correlation to surgical findings than 2D-MRI for detection of labral tears and some rotator cuff tears. Three-dimensional MRI may be used in place of traditional 2D-MRI in detection of soft-tissue shoulder injury in centers equipped to do so.

Magnetic Resonance Imaging of the Shoulder: Interpretation of Common Orthopaedic Injuries.

Magnetic resonance imaging (MRI) is frequently obtained to assess for pathology in the setting of shoulder pain and dysfunction. MRI of the shoulder provides diagnostic information that helps optimize patient management and surgical planning. Both general and subspecialized orthopaedic surgeons routinely order and review shoulder MRIs in practice. Therefore, familiarity with the MRI appearance of common shoulder pathologies is important. This document reviews the most common shoulder pathologies using a standardized MRI interpretative approach. Instructional videos demonstrating a musculoskeletal radiologist interpreting normal and abnormal shoulder MRIs are also provided.

Editorial Commentary: Patients May Have Posterior Glenoid Labral Tears in the Absence of Instability or Magnetic Resonance Imaging Findings.

Posterior labral tears occur more often than imagined 25 years ago. Although such tears are generally identified in patients with posterior shoulder instability, the spectrum of labral tears in patients without instability creates a challenging diagnosis. Both physical examination and magnetic resonance imaging interpretation are difficult. Pathology encompassing posterior labral tears without instability notably reveals differences compared with throwers with posterior labral tears and patients with posterior instability. Recent research has identified 3 tear types: occult (type 1), incomplete (type 2), and complete (type 3). Attention to diagnosis deserves critical attention, in addition to tailoring of repair techniques to address the appropriate conditions in the shoulder. Even in patients without posterior instability and with ambiguous magnetic resonance imaging or magnetic resonance arthrography findings, posterior shoulder pain during daily activities or sports may indicate a posterior labral tear. Arthroscopic posterior labral repair without capsular plication provides good clinical outcomes and high rates of return to sport and labral healing.

Shoulder and Elbow Injuries in Adult Overhead Throwers: Imaging Review.

Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation shifts the humeral head posterosuperiorly, predisposing to glenohumeral internal rotation deficit (GIRD), Bennett, posterosuperior internal impingement (PSI), and superior labrum anterior-posterior (SLAP) lesions. GIRD represents loss of internal rotation at the expense of external rotation. Bennett lesion represents ossification of the posteroinferior glenohumeral ligament due to repetitive traction. PSI manifests with humeral head cysts and "kissing" tears of the posterosuperior cuff and labrum. Scapular dysfunction contributes to symptoms of PSI and predisposes to labral or rotator cuff disease. "Peel-back" or SLAP lesions occur when torsional forces detach the biceps-labral anchor from the glenoid. Finally, disorders of the anterior capsule, latissimus dorsi, teres major, and subscapularis are well recognized in overhead throwers. At the elbow, injuries typically involve the medial-sided structures. The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and can be thickened, attenuated, ossified, and/or partially or completely torn. Medial epicondylitis can occur with tendinosis, partial tear, or complete rupture of the flexor-pronator mass and can accompany UCL tears and ulnar neuropathy. Posteromedial impingement (PMI) and valgus extension overload syndrome are related entities that follow abundant valgus forces during late cocking or acceleration, and deceleration. These valgus stresses wedge the olecranon into the olecranon fossa, leading to PMI, osteophytes, and intra-articular bodies. Other osseous manifestations include olecranon stress fracture and cortical thickening of the humeral shaft. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Chronic stage magnetic resonance imaging findings in patients with shoulder injury related to vaccine administration (SIRVA).

PURPOSE: Identify chronic shoulder MRI findings in patients with known shoulder injury related to vaccine administration (SIRVA). MATERIALS AND METHODS: Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the MRI of nine patients with clinically established SIRVA. MRI was performed at least 4 weeks after vaccination and included intravenous contrast-enhanced sequences. MRI was reviewed for the presence of erosions, tendonitis, capsulitis, synovitis, bone marrow oedema, joint effusion, bursitis, cartilage defects, rotator cuff lesions, and lymphadenopathy. The number and location of focal lesions were recorded. RESULTS: Erosions of the greater tuberosity were present in 8/9 (89%), tendonitis of the infraspinatus muscle tendon in 7/9 (78%), capsulitis, synovitis, and bone marrow oedema in 5/9 (56%) cases, respectively. Effusion was found in three, and subdeltoid bursitis, rotator cuff lesions as well as cartilage defects in one patient, respectively. None of our included subjects showed axillary lymphadenopathy. CONCLUSION: In this case series, greater humeral tuberosity erosions, infraspinatus muscle tendonitis, capsulitis, synovitis, and bone marrow oedema were common MRI findings in chronic SIRVA.

Accuracy of MR arthrography in the detection of posterior glenoid labral injuries of the shoulder.

OBJECTIVE: The purpose of this study is to evaluate the accuracy of MR arthrography in detecting isolated posterior glenoid labral injuries using arthroscopy as the reference standard. METHODS: MR arthrograms of 97 patients with isolated posterior glenoid labral tears by arthroscopy and those of 96 age and gender-matched controls with intact posterior labra were reviewed by two blinded radiologists for the presence and location of posterior labral abnormalities. The sensitivity and specificity of detection of posterior labral tears were calculated as well as the prevalence of associated pathologies. Medical records were reviewed for demographics, history and direction of shoulder instability, and prior surgery. RESULTS: Posterior labral pathology was detected by MR arthrography with sensitivities of 76% and 84% for readers 1 and 2, and a specificity of 88% for both readers. Kappa value for interreader agreement was 0.91. Twenty-two of twenty-three (96%) tears isolated to the posteroinferior quadrant on arthroscopy were correctly identified on MRI. Commonly associated pathologies included paralabral cyst (38%), humeral fracture (7%), and glenoid fracture (2%). Fifteen of ninety-seven (16%) patients with posterior tears on both arthroscopy and MRI had glenoid rim deficiency on imaging versus no patients with intact posterior labra (p < 0.001). Forty of ninety-seven (41%) patients with posterior tears on arthroscopy had a history of posterior instability versus none without posterior tears. There was no significant difference in tear length on MRI between those with a history of instability and those without (p = 0.56). CONCLUSION: MR arthrography is accurate in detecting posterior glenoid labroligamentous injuries.

An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography.

BACKGROUND: Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. PURPOSE: To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. MATERIAL AND METHODS: In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. RESULTS: According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images (P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% (P = 0.015). CONCLUSION: The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

Rotator Cuff Lesion in Wheelchair Users with Spinal Cord Injury: Does Time of Injury and Medullary Level Interfere? A Retrospective Evaluation / Lesão do manguito rotador em cadeirantes com lesão medular: O tempo de lesão e o nível medular interferem? Uma avaliação retrospectiva

Abstract Objective To describe magnetic resonance imaging (MRI) characteristics of shoulders from patients with spinal cord injury (SCI) and to correlate these findings with age, duration of SCI and neurological level. Method The study sample included patients with thoracic SCI over 18 years of age, who were active wheelchair users and had undergone an MRI of the shoulder from January 2004 to December 2015. Results We studied 41 shoulders (37 patients), including 27 men (65.9%) and 14 women (34.1%). At the time of MRI, the mean age was 41.9 years and the mean duration of SCI was 9.4 years. The analysis of the relationship between the duration of trauma and severity of the rotator cuff lesion (RCL), as well as between age and the severity of the shoulder injury showed a statistically significant difference (p< 0.001), with a positive association in both cases. No statistically significant difference (p= 0.095) was observed between the neurological level of the SCI and RCL. Conclusion In this study, a progressive increase in the severity of the shoulder lesions can be noted with advancing age and a longer duration of SCI. However, level of the SCI does not seem to interfere with RCL. Level of Evidence Level IV, case series.

Resumo Objetivo Descrever as características de ressonância magnética (RM) dos ombros de pacientes com lesão medular (LM) e correlacionar esses achados com idade, duração da LM e nível neurológico. Método A amostra do presente estudo incluiu pacientes maiores de 18 anos com LM torácica, que eram cadeirantes ativos e haviam sido submetidos a uma ressonância magnética do ombro de janeiro de 2004 a dezembro de 2015. Resultados Foram estudados 41 ombros (37 pacientes), incluindo 27 de pacientes do sexo masculino (65,9%) e 14 de pacientes do sexo feminino (34,1%). Na época da ressonância magnética, a média de idade era de 41,9 anos e a duração média da LM era de 9,4 anos. A análise da relação entre a duração do trauma e a gravidade da lesão do manguito rotador (LMR), bem como entre a idade e a gravidade da lesão do ombro mostrou diferença estatisticamente significativa (p< 0,001), com associação positiva em ambos os casos. Não foi observada diferença estatisticamente significativa (p= 0,095) entre o nível neurológico da LM e da LMR. Conclusão Neste estudo, pode-se notar um aumento progressivo da gravidade das lesões do ombro com o avanço da idade e uma maior duração da LM. No entanto, o nível da LM não parece interferir com a LMR. Nível de Evidência Nível IV, série de casos.

The Prevalence of Shoulder Disorders among Professional Bullfighters: A Cross-Sectional Ultrasonography Study.

We aimed to investigate clinical and ultrasound signs of shoulder overuse injuries in professional bullfighters; side-to-side differences (dominant vs. non-dominant); and to determine potential differences according to bullfighters' categories. An observational cross-sectional study was conducted. Thirty professional and active bullfighters were assessed. A bilateral ultrasound assessment of the subacromial bursa, long biceps head tendon (LHBT), and rotator cuff was performed to determine the presence of bursitis, subluxation, partial or total tendon rupture, tenosynovitis, or calcification. Supraspinatus tendon thickness was measured. Finally, a battery of clinical orthopedic tests (Yergason, Jobe, infraspinatus, Gerber, and bursa tests) were also performed. Most identified ultrasound findings were located in the dominant side, being the presence of bursitis (n = 9; 30%), LHBT tenosynovitis (n = 8; 26.7%), and subscapularis tendon calcification (n = 5; 16.7%) the most prevalent. No side-to-side or between-categories differences were found for supraspinatus tendon thickness (all, p > 0.05). The most frequent positive signs were the infraspinatus test (40.0%), Gerber lift-off test (33.3%), and bursitis, Jobe, and Yergason tests (all, 26.7%). Ultrasound signs were commonly found at LHBT, subacromial bursa, and rotator cuff in professional bullfighters without difference between categories and sides. No side-to-side or between-categories differences were found. Positive clinical test signs suggestive of bursitis, LHBT, and rotator cuff tendinopathy were frequently observed.

Observation on the Effect of Shoulder Pain Caused by Volleyball Training Injury Based on MRI Image Scanning.

In order to observe the effect of MRI image scanning on shoulder pain caused by volleyball training injury, this paper proposes to analyze the value of MR arthrography and conventional MRI image scanning in the diagnosis of shoulder injury. Taking the female volleyball players in a no. 1 middle school for nearly ten years as the research object, the injury investigation and statistics were carried out. The shoulder joint injury was investigated using arthroscopy and no injury was found. All patients underwent MR arthrography and routine MRI image scanning after admission. All patients underwent MR arthrography and routine MRI image scanning after admission. The patient took the flat lying position and put their arms flat on both sides of the body, and the Philips Achieva 3.0T MRI image scanning and Sense Flex M soft coil for MRI image scanning detection were used. The plain scan included oblique sagittal, axial, and oblique coronal proton density weighted image sequences; echo chain ETL = 6, TR/TE 2300/25 ms; and oblique sagittal and oblique coronal SET1W1; TRTE is 400/10 ms. Comparison was made with regard to the sensitivity, specificity, Jordan index, and accuracy of MR arthrography versus conventional MRI imaging in the diagnosis of shoulder injuries. The results were 38 true positives, 19 true negatives, 1 false positive, and 2 false negatives; a normal MRI scan showed 33 true positives, 13 true negatives, 7 false positives, and 7 false negatives. MR arthrography is more accurate than MRI image scanners in the diagnosis of shoulder injuries.

[Postoperative imaging of the shoulder]. / Postoperative Bildgebung des Schultergelenks.

BACKGROUND: Imaging of the postoperative shoulder joint includes complex, diagnostically challenging changes regarding the anatomical structures. OBJECTIVES: Case-based presentation of common surgical procedures, expected postoperative findings, and typical complications. MATERIALS AND METHODS: Interdisciplinary evaluation of (didactically instructive) cases and discussion of pertinent literature and expert opinions. RESULTS: Presentation of normal postoperative findings and complications after subacromial decompression, surgical treatment of rotator cuff lesions, SLAP (superior labral anterior to posterior) lesions/lesions of the long biceps tendon, Bankart lesions as well as instability-related procedures and after shoulder arthroplasty. Discussion of the appropriate use of imaging methods with a focus on magnetic resonance imaging (MRI), which are supplemented by computed tomography (CT), and conventional x­ray images. CONCLUSION: The broad spectrum of complex findings as well as the evermore developing and thereby changing surgical procedures result in significant challenges in the radiological evaluation of the postoperative shoulder joint. To differentiate physiological reactions from pathological changes it is necessary to have general knowledge of the common surgical procedures, expected postoperative findings and possible complications. A variety imaging modalities can be used to further advance diagnostic precision.

A Comparative Study on the Diagnostic Value of CTA and MRA in Anterior Dislocation of Shoulder.

Objective: To investigate the diagnostic value of CTA and MRA in anterior dislocation of shoulder. Methods: The detection of inferior glenohumeral ligament injuries, anterior inferior labrum injuries, and bone and cartilage injuries by the two examination procedures was observed and compared with the results of arthroscopy or surgery on patients referred to our hospital owing to anterior dislocation of shoulder. Results. A total of 36 patients with shoulder injuries were gathered for this study. 32 cases with anterior inferior labrum tearings (27 cases detected by CTA and 30 cases by MRA), 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA), 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA), and 24 cases with inferior glenohumeral ligament tearings (14 cases detected by CTA and 22 cases by MRA) were detected. There were 30 bone and cartilage injuries, including 18 fractures (CTA identified 18), 10 bone contusions (CTA detected 0), and 5 cartilage damage (CTA detected 0) (CTA detected 0, MRA detected 5). Conclusion: The detection rate of MRA is better than that of CTA for inferior glenohumeral ligament injuries. For anterior inferior labrum injury, the detection rate of CTA and MRA was similar. CTA is more conducive to the detection of fracture blocks, while MRA is more advantageous for the observation of bone contusion and cartilage damage.

Humeral Avulsion of the Glenohumeral Ligament: Diagnosis and Management.

¼: The most common type of humeral avulsion of the glenohumeral ligament (HAGL) is a purely ligamentous avulsion involving the anterior inferior glenohumeral ligament (IGHL), but other variants are seen, including posterior lesions and those with an osseous avulsion. ¼: A central lesion between the intact anterior and posterior bands of the IGHL is gaining recognition as a distinct clinical entity. ¼: HAGL lesions are most commonly seen in patients with anterior instability without a Bankart tear or in those with persistent symptoms despite having undergone a Bankart repair. ¼: Magnetic resonance imaging is the most sensitive imaging modality. An arthrogram is helpful with subacute and chronic lesions when the joint is not distended. Arthroscopy is the gold standard for diagnosis. ¼: While some have reported success with nonoperative management, surgical repair with either arthroscopic or open techniques has provided a high rate of successful outcomes; however, the literature is limited to mostly Level-IV and V evidence.

Image Quality and Diagnostic Performance of Accelerated Shoulder MRI With Deep Learning-Based Reconstruction.

BACKGROUND. Shoulder MRI using standard multiplanar sequences requires long scan times. Accelerated sequences have tradeoffs in noise and resolution. Deep learning-based reconstruction (DLR) may allow reduced scan time with preserved image quality. OBJECTIVE. The purpose of this study was to compare standard shoulder MRI sequences and accelerated sequences without and with DLR in terms of image quality and diagnostic performance. METHODS. This retrospective study included 105 patients (45 men, 60 women; mean age, 57.6 ± 10.9 [SD] years) who underwent a total of 110 3-T shoulder MRI examinations. Examinations included standard sequences (scan time, 9 minutes 23 seconds) and accelerated sequences (3 minutes 5 seconds; 67% reduction), both including fast spin-echo sequences in three planes. Standard sequences were reconstructed using the conventional pipeline; accelerated sequences were reconstructed using both the conventional pipeline and a commercially available DLR pipeline. Two radiologists independently assessed three image sets (standard sequence, accelerated sequence without DLR, and accelerated sequence with DLR) for subjective image quality and artifacts using 4-point scales (4 = highest quality) and identified pathologies of the subscapularis tendon, supraspinatus-infraspinatus tendon, long head of the biceps brachii tendon, and glenoid labrum. Interobserver agreement and agreement between image sets for the evaluated pathologies were assessed using weighted kappa statistics. In 27 patients who underwent arthroscopy, diagnostic performance was calculated using arthroscopic findings as a reference standard. RESULTS. Mean subjective image quality scores for readers 1 and 2 were 10.6 ± 1.2 and 10.5 ± 1.4 for the standard sequence, 8.1 ± 1.3 and 7.2 ± 1.1 for the accelerated sequence without DLR, and 10.7 ± 1.2 and 10.5 ± 1.6 for the accelerated sequence with DLR. Mean artifact scores for readers 1 and 2 were 9.3 ± 1.2 and 10.0 ± 1.0 for the standard sequence, 7.3 ± 1.3 and 9.1 ± 0.8 for the accelerated sequence without DLR, and 9.4 ± 1.2 and 9.8 ± 0.8 for the accelerated sequence with DLR. Interobserver agreement ranged from kappa of 0.813-0.951 except for accelerated sequence without DLR for the supraspinatus-infraspinatus tendon (κ = 0.673). Agreement between image sets ranged from kappa of 0.809-0.957 except for reader 1 for supraspinatus-infraspinatus tendon (κ = 0.663-0.700). Accuracy, sensitivity, and specificity for tears of the four structures were not different (p > .05) among image sets. CONCLUSION. Accelerated sequences with DLR provide 67% scan time reduction with similar subjective image quality, artifacts, and diagnostic performance to standard sequences. CLINICAL IMPACT. Accelerated sequences with DLR may provide an alternative to standard sequences for clinical shoulder MRI.

Imaging of Patients Suspected of SLAP Tear: A Cost-Effectiveness Study.

BACKGROUND. Superior labrum anterior and posterior (SLAP) tears are a common shoulder pathology. Although MRI is the imaging reference standard for diagnosis of this pathology, the cost-effectiveness of common MRI strategies is unclear. OBJECTIVE. The primary objective of our study was to determine the cost-effectiveness of the common MRI-based strategies used for the diagnosis of SLAP tears. METHODS. We created decision analytic models from the perspective of the U.S. health care system over a 2-year time horizon for a hypothetical population of 25-year-old patients with a previous diagnosis of SLAP tear. We used the decision models to compare the differences in incremental cost-effectiveness of the common MRI strategies, which included combinations of 1.5-T and 3-T MR arthrography (MRA) and unenhanced MRI protocols, and the resulting treatment applied for these patients. Input data on cost, probability, and utility estimates were obtained through a comprehensive literature search. The primary effectiveness outcome was quality-adjusted life years. Costs were estimated in 2017 U.S. dollars. RESULTS. When all imaging strategies were considered, the unenhanced 3-T MRI-based imaging strategy was the preferred and dominant option over 3-T MRA and 1.5-T imaging (MRI and MRA). When the model was run without 3-T imaging as an option, 1.5-T MRA was the favored option. Probabilistic sensitivity analyses confirmed the same preferred imaging strategy results. CONCLUSION. An unenhanced 3-T MRI-based strategy is the most cost-effective imaging option for patients with suspected SLAP tear. When 3-T imaging is not available, 1.5-T MRA is more cost-effective than 1.5-T MRI. The main driver of these results is the fact that 3-T MRI and 1.5-T MRA are the most specific tests in these respective scenarios, which results in fewer false-positives, prevents unnecessary surgeries, and leads to decreased costs. CLINICAL IMPACT. Our cost-effectiveness model findings complement prior diagnostic accuracy work, helping produce a more comprehensive approach to define imaging utility for radiologists, clinicians, and patients with SLAP tears who have access to various types of MRI options.