Multidetector computed tomography arthrography of the shoulder: diagnostic accuracy and indications.
BACKGROUND
The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality.


OBJECTIVE
To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard.


METHODS
After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study.


RESULTS
In the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (kappa=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques.


CONCLUSIONS
Arthro-MDCT of the shoulder is a safe technique that provides accurate diagnosis in identifying chondral, fibrocartilaginous, and intraarticular ligamentous lesions in patients who cannot be evaluated by MRI, and in patients after surgery.
Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Parma, Italy. massimo.defilippo@unipr.it
M
M
De Filippo
A
A
Bertellini
N
N
Sverzellati
F
F
Pogliacomi
C
C
Costantino
M
M
Vitale
M
M
Zappia
D
D
Corradi
G
G
Garlaschi
M
M
Zompatori
D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001175:Arthrography / Q000379:methods*; D001182:Arthroscopy; D000075202:Contraindications; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007592:Joint Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010698:Phobic Disorders; D019736:Prostheses and Implants; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D036542:Tomography, Spiral Computed / Q000379:methods*; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol