Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2019 | Magnetic Resonance Imaging | Research article

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Authors: Fanxiao Liu, Xiangyun Cheng, Jinlei Dong, Dongsheng Zhou, Qian Sun, Xiaohui Bai, Dawei Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Abstract

Background

Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT.

Methods

Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves.

Results

The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70–0.84) vs. 0.92 (95% CI 0.84–0.96), a specificity of 0.95 (95% CI 0.85–0.98) vs. 0.98 (95% CI 0.91–0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73–4.83) vs. 6.01 (95% CI 4.30–7.73), respectively.

Conclusion

MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

Alashkham A, Alraddadi A, Felts P, Soames R. Histology, vascularity and innervation of the glenoid labrum. J Orthop Surg (Hong Kong). 2018;26(2):2309499018770900. https://doi.org/10.1177/2309499018770900.CrossRef

Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995;11(2):180–4.CrossRef

Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pathoanatomy and surgical management. J Am Acad Orthop Surg. 1998;6(2):121–31.CrossRef

Tirman PF, Feller JF, Janzen DL, Peterfy CG, Bergman AG. Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance. Radiology. 1994;190(3):653–8. https://doi.org/10.1148/radiology.190.3.8115605.CrossRefPubMed

Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ. The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elb Surg. 1998;7(4):397–401.CrossRef

Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.CrossRef

Bak K, Spring BJ, Henderson JP. Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy. Am J Sports Med. 2000;28(4):466–71. https://doi.org/10.1177/03635465000280040501.CrossRefPubMed

Itoi E, Watanabe W, Yamada S, Shimizu T, Wakabayashi I. Range of motion after Bankart repair. Vertical compared with horizontal capsulotomy. Am J Sports Med. 2001;29(4):441–5. https://doi.org/10.1177/03635465010290041001.CrossRefPubMed

Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):1448–57. https://doi.org/10.2106/JBJS.D.02806.CrossRefPubMed

10.

Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB, LeClere L, Romeo AA. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am. 2010;92(Suppl 2):133–51. https://doi.org/10.2106/JBJS.J.00906.CrossRefPubMed

11.

Herzog RJ. Magnetic resonance imaging of the shoulder. Instr Course Lect. 1998;47:3–20.PubMed

12.

Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol. 2008;65(2):194–200. https://doi.org/10.1016/j.ejrad.2007.11.012.CrossRefPubMed

13.

Lederman ES, Flores S, Stevens C, Richardson D, Lund P. The Glenoid Labral articular teardrop lesion: a Chondrolabral injury with distinct magnetic resonance imaging findings. Arthroscopy. 2018;34(2):407–11. https://doi.org/10.1016/j.arthro.2017.08.236.CrossRefPubMed

14.

Jung JY, Yoon YC, Yi SK, Yoo J, Choe BK. Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder. Skelet Radiol. 2009;38(7):659–67. https://doi.org/10.1007/s00256-009-0660-7.CrossRef

15.

Dinauer PA, Flemming DJ, Murphy KP, Doukas WC. Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders. Skelet Radiol. 2007;36(3):195–202. https://doi.org/10.1007/s00256-006-0237-7.CrossRef

16.

Buckwalter KA. CT arthrography. Clin Sports Med. 2006;25(4):899–915. https://doi.org/10.1016/j.csm.2006.06.002.CrossRefPubMed

17.

Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol. 2009;192(1):86–92. https://doi.org/10.2214/AJR.08.1097.CrossRefPubMed

18.

Smith TO, Drew BT, Toms AP. A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury. Arch Orthop Trauma Surg. 2012;132(7):905–19. https://doi.org/10.1007/s00402-012-1493-8.CrossRefPubMed

19.

Arirachakaran A, Boonard M, Chaijenkij K, Pituckanotai K, Prommahachai A, Kongtharvonskul J. A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. Skelet Radiol. 2017;46(2):149–60. https://doi.org/10.1007/s00256-016-2525-1.CrossRef

20.

Ajuied A, McGarvey CP, Harb Z, Smith CC, Houghton RP, Corbett SA. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2018;138(5):699–709. https://doi.org/10.1007/s00402-018-2894-0.CrossRefPubMed

21.

El-Liethy N, Kamal H, Elsayed RF. Role of conventional MRI and MR arthrography in evaluating shoulder joint capsulolabral-ligamentous injuries in athletic versus non-athletic population. Egypt J Radiol Nucl Med. 2016;47(3):969–84. https://doi.org/10.1016/j.ejrnm.2016.05.001.CrossRef

22.

Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2645–50. https://doi.org/10.1007/s00167-014-3109-z.CrossRefPubMed

23.

Moroder P, Resch H, Schnaitmann S, Hoffelner T, Tauber M. The importance of CT for the pre-operative surgical planning in recurrent anterior shoulder instability. Arch Orthop Trauma Surg. 2013;133(2):219–26. https://doi.org/10.1007/s00402-012-1656-7.CrossRefPubMed

24.

McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. Jama. 2018;319(4):388–96. https://doi.org/10.1001/jama.2017.19163.CrossRefPubMed

25.

Schueler S, Schuetz GM, Dewey M. The revised QUADAS-2 tool. Ann Intern Med. 2012;156(4):323; author reply 323-324. https://doi.org/10.7326/0003-4819-156-4-201202210-00018.CrossRefPubMed

26.

Wade R, Corbett M, Eastwood A. Quality assessment of comparative diagnostic accuracy studies: our experience using a modified version of the QUADAS-2 tool. Res Synth Methods. 2013;4(3):280–6. https://doi.org/10.1002/jrsm.1080.CrossRefPubMed

27.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM. Group Q-: QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009.CrossRefPubMed

28.

Kim KW, Lee J, Choi SH, Huh J, Park SH. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part I. general guidance and tips. Korean J Radiol. 2015;16(6):1175–87. https://doi.org/10.3348/kjr.2015.16.6.1175.CrossRefPubMedPubMedCentral

29.

Lee J, Kim KW, Choi SH, Huh J, Park SH. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part II. Statistical methods of meta-analysis. Korean J Radiol. 2015;16(6):1188–96. https://doi.org/10.3348/kjr.2015.16.6.1188.CrossRefPubMedPubMedCentral

30.

Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93. https://doi.org/10.1016/j.jclinepi.2005.01.016.CrossRefPubMed

31.

Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. AJR Am J Roentgenol. 1990;155(4):829–32. https://doi.org/10.2214/ajr.155.4.2119117.CrossRefPubMed

32.

Chandnani VP, Yeager TD, DeBerardino T, Christensen K, Gagliardi JA, Heitz DR, Baird DE, Hansen MF. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1993;161(6):1229–35. https://doi.org/10.2214/ajr.161.6.8249731.CrossRefPubMed

33.

Sano H, Kato Y, Haga K, Itoi E, Tabata S. Magnetic resonance arthrography in the assessment of anterior instability of the shoulder: comparison with double-contrast computed tomography arthrography. J Shoulder Elb Surg. 1996;5(4):280–5.CrossRef

34.

Wallny T, Sommer T, Steuer K, Vahlensieck M, Wagner UA, Schmitz A, Schmitt O. Klinische und kernspintomographische Diagnostik von Labrumglenoidale-Verletzungen. Orthopädische Universitätsklinik Bonn. 1998;101.

35.

Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR. Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elb Surg. 2006;15(5):580–5. https://doi.org/10.1016/j.jse.2005.10.011.CrossRef

36.

Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? AJR Am J Roentgenol. 2011;196(5):1139–44. https://doi.org/10.2214/AJR.08.1734.CrossRefPubMed

37.

Fallahi F, Green N, Gadde S, Jeavons L, Armstrong P, Jonker L. Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology. Skelet Radiol. 2013;42(9):1225–33. https://doi.org/10.1007/s00256-013-1644-1.CrossRef

38.

Herold T, Hente R, Zorger N, Finkenzeller T, Feuerbach S, Lenhart M, Paetzel C. Indirect MR-arthrography of the shoulder-value in the detection of SLAP-lesions. Rofo. 2003;175(11):1508–14.

39.

Mahmoud MK, Badran YM, Zaki HG, Ali AH. One-shot MR and MDCT arthrography of shoulder lesions with arthroscopic correlation. Egypt J Radiol Nucl Med. 2013;44:273. https://doi.org/10.1016/j.ejrnm.2013.01.002.CrossRef

40.

Waterman BR, Arroyo W, Heida K, Burks R, Pallis M. SLAP repairs with combined procedures have lower failure rate than isolated repairs in a military population: surgical outcomes with minimum 2-year follow-up. Orthop J Sports Med. 2015;3(8):2325967115599154. https://doi.org/10.1177/2325967115599154.CrossRefPubMedPubMedCentral

41.

Tayrose GA, Karas SG, Bosco J. Biceps Tenodesis for Type II SLAP Tears. Bull Hosp Jt Dis (2013). 2015;73(2):116–21.

42.

Hantes M, Raoulis V. Arthroscopic findings in anterior shoulder instability. Open Orthop J. 2017;11:119–32. https://doi.org/10.2174/1874325001711010119.CrossRefPubMedPubMedCentral

43.

Amin MF, Youssef AO. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. Eur J Radiol. 2012;81(9):2343–7. https://doi.org/10.1016/j.ejrad.2011.07.006.CrossRefPubMed

44.

Yoneda M, Izawa K, Wakitani S, Nakasato S, Hayashida K, Nakagawa S. Diagnostic imaging of unstable superior glenoid labral detachment: a comparison between MR arthrography and unenhanced MRI. Mod Rheumatol. 2001;11(2):140–4. https://doi.org/10.3109/s101650170026.CrossRefPubMed

45.

Acid S, Le Corroller T, Aswad R, Pauly V, Champsaur P. Preoperative imaging of anterior shoulder instability: diagnostic effectiveness of MDCT arthrography and comparison with MR arthrography and arthroscopy. AJR Am J Roentgenol. 2012;198(3):661–7. https://doi.org/10.2214/AJR.11.7251.CrossRefPubMed

46.

Godefroy D, Sarazin L, Rousselin B, Dupont AM, Drape J, Chevrot A. Shoulder imaging: what is the best modality? J Radiol. 2001;82(3 Pt 2):317–32 quiz 333-314.PubMed

47.

Sommer T, Vahlensieck M, Wallny T, Lutterbey G, Pauleit D, Steuer K, Golombek V, Kreft B, Keller E, Schild H. Indirect MR arthrography in the diagnosis of lesions of the labrum glenoidale. Rofo. 1997;167(1):46–51. https://doi.org/10.1055/s-2007-1015490.CrossRefPubMed

48.

Familiari F, Huri G, Simonetta R, McFarland EG. SLAP lesions: current controversies. EFORT Open Rev. 2019;4(1):25–32. https://doi.org/10.1302/2058-5241.4.180033.CrossRefPubMedPubMedCentral

49.

Stewart JK, Taylor DC, Vinson EN. Magnetic resonance imaging and clinical features of glenoid labral flap tears. Skelet Radiol. 2017;46(8):1095–100. https://doi.org/10.1007/s00256-017-2664-z.CrossRef

50.

Baudi P, Rebuzzi M, Matino G, Catani F. Imaging of the unstable shoulder. Open Orthop J. 2017;11:882–96. https://doi.org/10.2174/1874325001711010882.CrossRefPubMedPubMedCentral

51.

Kim DS, Yoon YS, Kwon SM. The spectrum of lesions and clinical results of arthroscopic stabilization of acute anterior shoulder instability. Yonsei Med J. 2010;51(3):421–6. https://doi.org/10.3349/ymj.2010.51.3.421.CrossRefPubMedPubMedCentral

52.

Cerezal L, Garcia-Valtuille R, Canga A, Rolon A, Abascal F. Magnetic resonance arthrography indications and technique (I). Upper limb. Radiologia. 2006;48(6):341–56.CrossRef

Title: Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis
Authors: Fanxiao Liu
Xiangyun Cheng
Jinlei Dong
Dongsheng Zhou
Qian Sun
Xiaohui Bai
Dawei Wang
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Arthrography
Arthroscopy
Arthroscopy
Published in: BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-019-2876-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Morphological analysis for subaxial cervical pedicle screw insertion in developmental and non-developmental canal stenosis

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

Longitudinal validity of using digital hand photographs for assessing hand osteoarthritis progression over 7 years in community-dwelling older adults with hand pain

Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus

Long-term results of the iBP elbow prosthesis: beware of destructive metallosis!

Non-contemporaneous bilateral stem fractures occurring after staged bilateral hip revision using extensively porous-coated cylindrical femoral stems: a case report