title: Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players.
abstract: Purpose To evaluate a combined imaging approach with both ultrasonography (US; conventional US and valgus stress US) and magnetic resonance (MR) arthrography in baseball players with medial elbow pain. Materials and Methods Institutional review board approval was obtained and the requirement for informed consent was waived. The study is compliant with HIPAA. Baseball players with medial elbow pain underwent US in addition to MR arthrography. Findings were assessed with each modality alone and both combined in this retrospective investigation. For the evaluation of ulnar collateral ligament (UCL) tears with stress US, the interval gapping of the medial elbow joint was measured between rest and valgus stress both at the injured and at the uninjured (contralateral) elbow. Surgical or arthroscopic correlation was available as the so-called gold standard. McNemar tests compared the accuracies of the imaging modalities. Results In this study, 144 baseball players had 191 findings of medial elbow pain, including 53 UCL tears. With stress US, joint gapping at the injured elbow greater than 1.0 mm compared with the contralateral elbow yielded a sensitivity, specificity, and accuracy of 96%, 81%, and 87%, respectively, for diagnosing UCL tears. With MR arthrography, the sensitivity, specificity, and accuracy for UCL tears were 81%, 91%, and 88%, respectively, and increased to 96% (P = .013, McNemar test), 99% (P = .023), and 98% (P < .001), respectively, when combined with US to a dual modality MR and US approach. For 31 patients with ulnar neuritis, the sensitivity, specificity, and accuracy increased from 74%, 92%, and 88%, respectively, with MR arthrography alone to 90% (P = .07, McNemar test), 100% (P < .001), and 98% (P < .001) combined with US. For the 59 myotendinous and the 48 osteochondral diagnoses, the sensitivity, specificity, and accuracy with MR arthrography alone were 93%, 93%, and 93%, and 94%, 98%, and 97%, respectively, with no additional diagnostic value from US. Conclusion The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain. (©) RSNA, 2016.
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Roedl
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Felix M
authors.initials: FM
authors.lastname: Gonzalez
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Adam C
authors.initials: AC
authors.lastname: Zoga
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: William B
authors.initials: WB
authors.lastname: Morrison
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Mika T
authors.initials: MT
authors.lastname: Nevalainen
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ciccotti
authors.affiliation: From the Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, 132 S 10th St, Philadelphia, PA 19107 (J.B.R., F.M.G., A.C.Z., W.B.M., M.T.N., L.N.N.); and Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Jefferson Medical College, Philadelphia, Pa (M.G.C.).
authors.forename: Levon N
authors.initials: LN
authors.lastname: Nazarian
mesh_terms: D000328:Adult; D001182:Arthroscopy; D001484:Baseball / Q000293:injuries*; D000070637:Collateral Ligament, Ulnar / Q000293:injuries; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020424:Ulnar Neuropathies / Q000000981:diagnostic imaging; D014463:Ultrasonography; D000092464:Elbow Injuries