Korean J Radiol.  2001 Dec;2(4):216-221. 10.3348/kjr.2001.2.4.216.

Comparison between Conventional MR Arthrograhphy and Abduction and External Rotation MR Arthrography in Revealing Tears of the Antero-Inferior Glenoid Labrum

• Choi JA
• Suh SI
• Kim BH
• Cha SH
• Kim MG
• Lee KY
• Lee CH

• KMID: 754091
• DOI: http://doi.org/10.3348/kjr.2001.2.4.216

Abstract

OBJECTIVE
To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. MATERIALS AND METHODS: MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. RESULTS: In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). CONCLUSION: MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.

Keyword

Shoulder, arthrography; Shoulder, injuries ; Shoulder, MR

MeSH Terms

Adolescent
Adult
Arthrography
Cartilage, Articular/*injuries
Comparative Study
Female
Human
Magnetic Resonance Imaging/*methods
Male
Movement
Recurrence
Shoulder/*injuries
Shoulder Dislocation/*etiology

Figure

• 

  Fig. 1 In a 20-year-old man with a history of recurrent anterior shoulder dislocation, a grade-2 anterior glenoid labral tear is revealed by both axial and abduction and external rotation images. A. Axial fat-suppressed T1-weighted MR arthrogram reveals subtle increased signal intensity in the anterior glenoid labrum (arrow). B. Abduction and external rotation oblique axial fat-suppressed T1-weighted MR arthrogram of this same region shows similar findings (arrow).

• 

  Fig. 2 In a 24-year-old man with a history of recurrent anterior shoulder dislocation, a grade-3 anterior glenoid labral tear is seen on both axial and abduction and external rotation images. A. Axial fat-suppressed T1-weighted MR arthrogram shows contrast material filling the tear (arrow) in the anterior glenoid labrum. B. Abduction and external rotation oblique axial fat-suppressed T1-weighted MR arthrogram also reveals contrast material filling the gap between the anterior glenoid labrum and glenoid rim, showing a Bankart lesion (arrow).

• 

  Fig. 3 In a 20-year-old man with a history of recurrent anterior shoulder dislocation, axial scanning demonstrates a grade-2 anterior glenoid labral tear. Abduction and external rotation scanning, however, indicates that this is grade 3. A. Axial fat-suppressed T1-weighted MR arthrogram shows slightly increased signal intensity of the anterior glenoid labrum. B. Abduction and external rotation oblique axial fat-suppressed T1-weighted MR arthrogram reveals a contrast material-filled gap between the labrum and the glenoid rim (arrow).

• 

  Fig. 4 In a 19-year-old man with a history of recurrent anterior shoulder dislocation, axial scanning demonstrates a grade-1 anterior glenoid labral tear, but an abduction and external rotation-position scan indicates that this is grade 3. A. On this axial fat-suppressed T1-weighted MR arthrogram, the presence of an anterior glenoid labrum tear is seen. B. Abduction and external rotation oblique axial fat-suppressed T1-weighted MR arthrogram reveals detached labral tear with periosteal stripping (arrow).

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