title: Efficacy of diagnostic magnetic resonance imaging for articular cartilage lesions of the glenohumeral joint in patients with instability.
abstract: OBJECTIVE
  The purpose of this study was primarily to assess the diagnostic performance of magnetic resonance imaging (MRI) in detecting articular cartilage injuries in patients with glenohumeral instability. A secondary purpose was to assess the diagnostic performance of MRI for detection of Hill-Sachs and Bankart lesions.
  
  
  METHODS
  A cohort of 87 consecutive patients who underwent diagnostic MRI and shoulder arthroscopy for instability from 1997 to 2006 were identified. Fifty-five patients (63.2%) underwent MRI with intra-articular contrast medium and 32 patients (36.8%) underwent MRI without contrast medium. MR images were reviewed by two radiologists and interpreted by consensus for the presence of articular cartilage lesions (including Hill-Sachs and Bankart lesions), which were then confirmed by reviewing the operative report and images recorded at arthroscopy.
  
  
  RESULTS
  Mean patient age was 27.0 ± 10.2 years with a mean clinical and radiographic follow-up of 29 (range 3-72) months. Cartilage injuries were detected arthroscopically in 55 patients (63%). Bankart and Hill-Sachs lesions were identified arthroscopically in 66 patients (75.9%) and 55 patients (63.2%) respectively. The overall sensitivity and specificity for detection of glenohumeral articular cartilage lesions by MRI were 87.2% and 80.6% respectively. The sensitivity and specificity of MRI in detecting Bankart lesions was 98.4% (95% CI 91.9, 99.7) and 95.2% (95% CI 77.3, 99.2) respectively. The sensitivity and specificity of MRI in detecting Hill-Sachs lesions was 96.3% (95% CI 87.6, 98.9%) and 90.6% (95% CI 75.7, 96.9) respectively. No statistically significant difference was found between MRI examinations with and without intra-articular gadolinium (p = 0.89).
  
  
  CONCLUSIONS
  Magnetic resonance imaging demonstrates high sensitivity and specificity for the diagnosis of articular cartilage injuries in patients with glenohumeral instability. MRI with or without intra-articular contrast medium in this study were equally reliable as a non-invasive method for assessment of articular cartilage damage of the glenohumeral joint prior to diagnostic arthroscopy.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Hayes
authors.forename: Mark S
authors.initials: MS
authors.lastname: Collins
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Doris E
authors.initials: DE
authors.lastname: Wenger
authors.forename: Diane L
authors.initials: DL
authors.lastname: Dahm
mesh_terms: D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007593:Joint Instability / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000503:physiopathology*; D000070599:Shoulder Injuries; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media
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