2017 ISAKOS Biennial Congress ePoster #2018

 

Diagnostic Effectiveness of MD-CT Arthrography in Shoulder Instability and Its Comparison with MR Arthrography and Arthroscopy

Vinod Kumar, MBBS, MS, DNB, MNAMS, New Delhi, New Delhi INDIA
Jeetendra Lodhi, MBBS,MS, New Delhi, Delhi INDIA
Dhananjaya Sabat, MS, DNB, MNAMS, New Delhi, New Delhi INDIA
Shekhar Tank, MBBS, MS, Delhi, Delhi INDIA
Rakesh Sehrawat, MBBS, MS, Ghaziabad , Uttar Pradesh INDIA
Deepak Gupta, MBBS, MS, New Delhi, Delhi INDIA

Maulana Azad Medical College, New Delhi, Delhi, INDIA

FDA Status Cleared

Summary

Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography in shoulder instability (to detect various kinds of lesions eg. Bankart’s lesion, Hill Sach’s lesion, SLAP tear etc.) and its comparison to MR arthrography and arthroscopy taking arthroscopy as gold standard

Abstract

Background

Purpose

of this study was to compare diagnostic effectiveness of MDCT arthrography in shoulder instability (to detect various kinds of lesions eg. Bankart’s lesion, Hill Sach’s lesion, SLAP tear etc.) and its comparison to MR arthrography and arthroscopy taking arthroscopy as gold standard.
Methods:20 patients with history of recurrent shoulder dislocation or pain particular in throwing were included in this study. After detail clinical examination each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician.

Results

At arthroscopy, 10 Bankart’s lesions (4 classic Bankart’s lesion, 2 reverse Bankart’s lesions, 4 bony Bankart’s lesion), 6 SLAP lesion (1 case had combined Bankart’s and SLAP lesions), 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and one supraspinatus fraying were visualized in 20 shoulders. Four cases with Bankart’s lesions and one ALPSA lesion had associated Hill-Sach’s lesions and two reverse Bankart’s lesions were associated with reverse Hill-Sach’s lesions.
Eight cases were correctly diagnosed as Bankart’s lesions by MDCTA while MRA detected nine cases and each imaging modality missed the diagnosis of two and one arthroscopy proved Bankart’s lesion respectively.
Also, one Hill-Sachs lesion was missed by MRA while, correctly diagnosed by MDCTA. All ALPSA lesions were correctly diagnosed by both imaging modalities. One case was falsely diagnosed as having ALPSA and Hill-Sachs lesion both on MDCTA and MRA.
For SLAP lesions, five cases were diagnosed by both MDCTA and MRA.
With the help of the statistician sensitivity, specificity, positive predictive value and negative predictive value were calculated. For Bankart’s lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value 100%, negative predictive value 83.3%. MRA has sensitivity of 90%, specificity 100%, positive predictive value 100%, negative predictive value 90.9%.
With SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%.
With Hill-Sachs lesion sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively.
For ALPSA sensitivity 100%, specificity 95%, PPV 50% and NPV 100% both for MDCTA and MRA.
kappa coefficient for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement.

Conclusion

Considering availability, cost, time consumption, superiority in detecting bony lesions and comparable in soft tissue lesions detection MDCTA can be used as single investigation of choice in shoulder instability.