Is MRA an unnecessary expense in the management of a clinically unstable shoulder? A comparison of MRA and arthroscopic findings in 90 patients.
Acta Orthop
; 83(3): 267-70, 2012 Jun.
Article
en En
| MEDLINE
| ID: mdl-22401678
BACKGROUND AND PURPOSE: In detection of glenoid labrum pathology, MR arthrography (MRA) has shown sensitivities of 88-100% and specificities of 89-93%. However, our practice suggested that there may be a higher frequency of falsely negative reports. We assessed the accuracy of this costly modality in practice. PATIENTS AND METHODS: We retrospectively reviewed MRA reports of 90 consecutive patients with clinical shoulder instability who had undergone shoulder arthroscopy. All had a history of traumatic anterior shoulder dislocation and had positive anterior apprehension tests. All underwent arthroscopy and stabilization during the same procedure. We compared the findings, using arthroscopic findings as the gold standard in the identification of glenoid labrum pathology. RESULTS: 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%). INTERPRETATION: The sensitivity of MRA in this series was substantially lower than previously published, suggesting that MRA may not be as reliable a diagnostic imaging modality in glenohumeral instability as previously thought. Our findings highlight the importance of an accurate history and clinical examination in the management of glenohumeral instability. The need for MRA may not be as high as is currently believed.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Imagen por Resonancia Magnética
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Artrografía
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Lesiones del Hombro
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Inestabilidad de la Articulación
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Evaluation_studies
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
Límite:
Adult
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Humans
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Middle aged
Idioma:
En
Revista:
Acta Orthop
Asunto de la revista:
ORTOPEDIA
Año:
2012
Tipo del documento:
Article
Pais de publicación:
Suecia