MRI Allows Accurate Measurement of Glenoid Bone Loss

医学 射线照相术 肩膀 放射科 矢状面 磁共振成像 前肩 Bankart修复 核医学 外科
作者
Mirco Sgroi,Hashuka Huzurudin,Marius Ludwig,Timo Zippelius,Heiko Reichel,Thomas Kappe
出处
期刊:Clinical Orthopaedics and Related Research [Lippincott Williams & Wilkins]
卷期号:480 (9): 1731-1742 被引量:5
标识
DOI:10.1097/corr.0000000000002215
摘要

Bony Bankart lesions larger than a certain size can lead to a high redislocation rate, despite treatment with Bankart repair. Detection and measurement of glenoid bone loss play key roles in selecting the appropriate surgical therapy in patients with shoulder instability. There is controversy about which diagnostic modalities, using different measurement methods, provide the best diagnostic validity.(1) What are the diagnostic accuracies of true AP radiographs, West Point (WP) view radiographs, MRI, and CT to detect glenoid bone loss? (2) Are there differences in the measurements of glenoid bone loss on MRI and CT? (3) What are the intrarater and interrater reliabilities of CT and MRI to measure glenoid bone loss?Between August 2012 and February 2017, we treated 80 patients for anterior shoulder instability. Of those, we considered patients with available preoperative true AP radiographs, WP radiographs, CT images, and MR images of the affected shoulder as potentially eligible. Based on that, 63% (50 of 80) of patients were eligible for analysis; 31% (25 of 80) were excluded because not all planes or slices (such as sagittal, axial, or frontal) of each diagnostic imaging modalities were available and 7% (5 of 80) because of the insufficient quality of diagnostic images (for example, setting of the layers did not allow adequate en face view of the glenoid). Preoperative true AP radiographs, WP radiographs, CT images and MR images of the affected shoulders were retrospectively assessed for the presence of glenoid bone loss by two blinded observers at a median (range) 25 months (12 to 66) postoperatively. To evaluate sensitivity, specificity, positive predictive value, negative predictive value, accuracy, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC), we compared the detection of glenoid bone loss at follow-up achieved with the aforementioned imaging modalities with intraoperative arthroscopic detection. In all patients with glenoid bone loss, two blinded observers measured the size of the glenoid bone loss on preoperative CT and MR images using six measuring techniques: depth and length of the glenoid bone loss, Bigliani classification, best-fit circle width loss method, AP distance method, surface area method, and Gerber X ratio. Subsequently, the sizes of the glenoid bone loss determined using CT and MRI were compared. To estimate intraobserver and interobserver reliability, measurements were performed in a blinded fashion by two observers. Their level of experience was equivalent to that of orthopaedic residents, and they completed a training protocol before the measurements.For the ability to accurately diagnose Bankart lesions, the AUC (accuracy of a diagnostic test; the closer to 1.0, the more accurate the test) was good for MRI (0.83 [95% confidence interval 0.70 to 0.94]; p < 0.01), fair for CT (0.79 [95% CI 0.66 to 0.92]; p < 0.01), poor for WP radiographs (0.69 [95% CI 0.54 to 0.85]; p = 0.02) and failed for true AP radiographs (0.55 [95% CI 0.39 to 0.72]; p = 0.69). In paired comparisons, there were no differences between CT and MRI regarding (median [range]) lesion width (2.33 mm [0.35 to 4.53] versus 2.26 mm [0.90 to 3.47], p = 0.71) and depth (0.42 mm [0.80 to 1.39] versus 0.40 mm [0.06 to 1.17]; p = 0.54), and there were no differences concerning the other measurement methods: best-fit circle width loss method (15.02% [2.48% to 41.59%] versus 13.38% [2.00% to 36.34%]; p = 0.66), AP distances method (15.48% [1.44% to 42.01%] versus 12.88% [1.43% to 36.34%]; p = 0.63), surface area method (14.01% [0.87% to 38.25] versus 11.72% [2.45% to 37.97%]; p = 0.68), and Gerber X ratio (0.75 [0.13 to 1.47] versus 0.76 [0.27 to 1.13]; p = 0.41). Except for the moderate interrater reliability of the Bigliani classification using CT (intraclass correlation coefficient = 0.599 [95% CI 0.246 to 0.834]; p = 0.03) and acceptable interrater reliability of the Gerber X ratio using CT (0.775 [95% CI 0.542 to 0.899]; p < 0.01), all other measurement methods had good or excellent intrarater and interrater reliabilities on MRI and CT.The results of this study show that CT and MRI can accurately detect glenoid bone loss, whereas WP radiographs can only recognize them poorly, and true AP radiographs do not provide any adequate diagnostic accuracy. In addition, when measuring glenoid bone loss, MRI images of the analyzed measurement methods yielded sizes that were no different from CT measurements. Finally, the use of MRI images to measure Bankart bone lesions gave good-to-excellent reliability in the present study, which was not inferior to CT findings. Considering the advantages including lower radiation exposure and the ability to assess the condition of the labrum using MRI, we believe MRI can help surgeons avoid ordering additional CT imaging in clinical practice for the diagnosis of anterior shoulder instability in patients with glenoid bone loss. Future studies should investigate the reproducibility of our results with a larger number of patients, using other measurement methods that include examination of the opposite side or with three-dimensional reconstructions.Level I diagnostic study.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
1秒前
qweerrtt完成签到,获得积分10
8秒前
8秒前
与共发布了新的文献求助10
9秒前
carly完成签到 ,获得积分10
10秒前
颢懿完成签到 ,获得积分10
13秒前
量子星尘发布了新的文献求助10
14秒前
16秒前
ljc完成签到 ,获得积分10
17秒前
Java完成签到,获得积分10
21秒前
23秒前
鲤鱼安青完成签到 ,获得积分10
25秒前
25秒前
dollarpuff完成签到 ,获得积分10
28秒前
28秒前
mmmmmMM完成签到,获得积分10
35秒前
luckweb完成签到,获得积分10
41秒前
猫的毛完成签到 ,获得积分10
42秒前
nicky完成签到 ,获得积分10
43秒前
麦子完成签到 ,获得积分10
44秒前
44秒前
Wilson完成签到 ,获得积分10
45秒前
luckweb发布了新的文献求助10
45秒前
45秒前
49秒前
52秒前
传奇3应助wujiwuhui采纳,获得10
54秒前
开心寄松完成签到,获得积分10
56秒前
北宫完成签到 ,获得积分10
56秒前
wansida完成签到,获得积分10
1分钟前
QXS完成签到 ,获得积分10
1分钟前
1分钟前
菠萝完成签到 ,获得积分10
1分钟前
领导范儿应助Villanellel采纳,获得10
1分钟前
wintersss完成签到,获得积分10
1分钟前
尹尹发布了新的文献求助10
1分钟前
量子星尘发布了新的文献求助10
1分钟前
zzzzzz完成签到 ,获得积分10
1分钟前
坦率的枕头完成签到,获得积分10
1分钟前
XS_QI完成签到 ,获得积分10
1分钟前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038066
求助须知:如何正确求助?哪些是违规求助? 3575779
关于积分的说明 11373801
捐赠科研通 3305584
什么是DOI,文献DOI怎么找? 1819239
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022