J Korean Soc Radiol.  2012 Dec;67(6):465-472. 10.3348/jksr.2012.67.6.465.

Diagnostic Accuracy and Inter-Observer Agreement of Shoulder Magnetic Resonance Arthrography in the Detection of Labral Lesion and Assessment of Lesion Location

• Hwang JY
• Song SY
• Choi J
• Shin SJ

• KMID: 2097983
• DOI: http://doi.org/10.3348/jksr.2012.67.6.465

Abstract

PURPOSE
To evaluate the diagnostic accuracy and inter-observer agreement of magnetic resonance (MR) arthrography in the detection of labral lesions by location and to describe useful MR imaging findings of labral tears.
MATERIALS AND METHODS
Sixty-eight patients who underwent both pre-operative MR arthrography and arthroscopy were included. The location of the labrum was classified into anterior (2-6 o'clock), superior (12-2 o'clock), and posterior (6-12 o'clock). Sensitivity, specificity, accuracy, and inter-observer agreement of MR arthrography for the diagnosis of labral lesions by location were calculated. Frequency of MR imaging findings such as detachment, high signal intensity cleft, contour change, absence, and signal change of the labrum by location were analyzed.
RESULTS
35 anterior, 44 superior and 15 posterior labral lesions were detected by arthroscopy. The corresponding sensitivities were 91.4%, 79.5%, and 40.0%, specificities were 90.9%, 20.8%, and 86.8%, accuracies were 91.2%, 58.8%, and 76.5%, and kappa values were 0.823, 0.252, and 0.394, for anterior, superior, posterior lesions, respectively. The most common MR imaging findings were detachment in 60.0% of anterior labrums, high signal intensity cleft in 52.3% of superior labrums, and normal in 60.0% of posterior labrums.
CONCLUSION
Diagnostic accuracy and inter-observer agreement of MR arthrography in the diagnosis of labral lesions are high in anterior labrums and low in superior or posterior labrums. The useful MR imaging findings of labral tears were different according to labral location.

MeSH Terms

Arthrography
Arthroscopy
Humans
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Sensitivity and Specificity
Shoulder

Figure

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  Fig. 1 Transverse (A), oblique coronal (B), and oblique sagittal (C) fat-saturated T1-weighted magnetic resonance (MR) arthrogram of the left shoulder in a 20-year-old man demonstrate detachment and anterior displacement of the anterior labrum (black arrow) and high signal intensity cleft (arrowhead) in superior labrum. The MR result of the posterior labrum (white arrow) is discordant between readers which is interpreted as small with blunted margin by reader 1 and as normal by reader 2. On arthroscopy, superior and anterior labral tear is diagnosed from 10 o'clock to 6 o'clock and posterior labrum appears to be normal (not shown).

• 

  Fig. 2 A 19-year-old man with anterior labral tear (2-4 o'clock). Fat-saturated transverse T1-weighted images (A obtained cephalad to B) show absent anterior labrum with smooth glenoid margin.

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  Fig. 3 Magnetic resonance arthrograms from three different patients with or without superior labral lesions. A. A 36-year-old man with type II SLAP lesion confirmed with arthroscopy. Fat-saturated oblique coronal T1-weighted image shows laterally pointed, high signal intensity cleft from 10 to 12 o'clock (arrow), which was interpreted as tear by both readers. B. A 26-year-old man with type II SLAP lesion confirmed with arthroscopy. Fat-saturated oblique coronal T1-weighted image shows medially pointed, irregular high signal intensity at insertion site of biceps tendon (arrowhead), which was interpreted as normal by reader 1 and as tear by reader 2. C. A 19-year-old man without superior labral lesion by arthroscopy. Fat-saturated oblique coronal T1-weighted image show similar findings to A (arrowhead), which was interpreted as normal by reader 1 and as tear by reader 2. Note.-SLAP = superior labrum anterior and posterior tear

• 

  Fig. 4 A 28-year-old man with posterior and anterior labral tear (3-9 o'clock) confirmed with arthroscopy. Fat-saturated transverse T1-weighted image shows normal appeared posterior labrum (white arrow) by both readers. Concomitant anterior labral lesion is seen as increased signal intensity without poorly differentiated labrum (black arrow) because of synovial fibrous tissue and labral degeneration.

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