title: Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome.
abstract: OBJECTIVE
  To determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of magnetic resonance (MR) arthrography in detecting such cartilage abnormalities.
  
  
  METHODS
  MR arthrographic images obtained in 52 consecutive patients (mean age, 45.8 years; age range, 17-73 years; 26 male and 26 female patients) were retrospectively evaluated for glenohumeral cartilage lesions. Two experienced musculoskeletal radiologists who were blinded to the arthroscopy report independently analyzed the articular cartilage. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Arthroscopic findings were the standard of reference. Sensitivity, specificity, accuracy, and interobserver agreement were calculated.
  
  
  RESULTS
  At arthroscopy, humeral cartilage lesions were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid were less frequent (eight patients; frequency, 15%): Three were subtle, and five were marked. For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (humeral lesions, kappa = 0.20; glenoidal lesions, kappa = 0.27).
  
  
  CONCLUSIONS
  Glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The performance of MR arthrography in the detection of glenohumeral cartilage lesions is moderate.
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Guntern
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.forename: Marius R
authors.initials: MR
authors.lastname: Schmid
authors.forename: Marco
authors.initials: M
authors.lastname: Zanetti
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Binkert
authors.forename: Alberto G
authors.initials: AG
authors.lastname: Schneeberger
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000473:pathology*; D012785:Shoulder Joint