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Semin Musculoskelet Radiol 2012; 16(01): 003-014
DOI: 10.1055/s-0032-1304297
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

MR and CT Arthrography of the Shoulder

Richard B. Rhee
1   Department of Radiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California.
2   Newport Harbor Radiology Associates, Newport Beach, California.
3   Department of Orthopaedic Surgery, University of California Irvine, Orange, California.
,
Karence K. Chan
1   Department of Radiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California.
2   Newport Harbor Radiology Associates, Newport Beach, California.
,
John G. Lieu
1   Department of Radiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California.
2   Newport Harbor Radiology Associates, Newport Beach, California.
,
Brian S. Kim
1   Department of Radiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California.
2   Newport Harbor Radiology Associates, Newport Beach, California.
,
Lynne S. Steinbach
4   Department of Radiology, University of California San Francisco, San Francisco, California.
5   Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California.
› Author Affiliations
Further Information

Publication History

Publication Date:
23 March 2012 (online)

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Abstract

The combined use of shoulder arthrography with MR and CT imaging offers distinct advantages over conventional nonarthrographic imaging techniques. The improved contrast and joint distension afforded by direct arthrography optimize evaluation of various intra-articular structures and help to define subtle abnormalities and distinguish normal variants from true shoulder pathology. In this article, we review the rationale and basic approaches to shoulder arthrography as well as the imaging appearance of the normal shoulder, anatomical variants, and pathology highlighted by this technique.

Keywords

shoulder arthrography - MR arthrography - CT arthrography
 

  • References

  • 1 Oberholzer J. Die Arthropneumoradiographie bei Habitueller Shulterluxation. Rontgen Praxis 1933; 5: 589-590
    PubMedGoogle Scholar
  • 2 Peterson JJ, Bancroft LW. History of arthrography. Radiol Clin North Am 2009; 47 (3) 373-386
    CrossrefPubMedGoogle Scholar
  • 3 Hajek PC, Baker LL, Sartoris DJ, Neumann CH, Resnick D. MR arthrography: anatomic-pathologic investigation. Radiology 1987; 163 (1) 141-147
    CrossrefPubMedGoogle Scholar
  • 4 Piper SL, Kim HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am 2008; 90 (5) 986-991
    CrossrefPubMedGoogle Scholar
  • 5 Lo IK, Sciore P, Chung M , et al. Local anesthetics induce chondrocyte death in bovine articular cartilage disks in a dose- and duration-dependent manner. Arthroscopy 2009; 25 (7) 707-715
    CrossrefPubMedGoogle Scholar
  • 6 Giaconi JC, Link TM, Vail TP , et al. Morbidity of direct MR arthrography. AJR Am J Roentgenol 2011; 196 (4) 868-874
    CrossrefPubMedGoogle Scholar
  • 7 Hodler J. Technical errors in MR arthrography. Skeletal Radiol 2008; 37 (1) 9-18
    PubMedGoogle Scholar
  • 8 Jung JY, Yoon YC, Yi SK, Yoo J, Choe BK. Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder. Skeletal Radiol 2009; 38 (7) 659-667
    CrossrefPubMedGoogle Scholar
  • 9 Herold T, Bachthaler M, Hamer OW , et al. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Radiology 2006; 240 (1) 152-160
    CrossrefPubMedGoogle Scholar
  • 10 Vahlensieck M, Sommer T, Textor J , et al. Indirect MR arthrography: techniques and applications. Eur Radiol 1998; 8 (2) 232-235
    CrossrefPubMedGoogle Scholar
  • 11 Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 2005; 21 (1) 77-80
    CrossrefPubMedGoogle Scholar
  • 12 Catalano OA, Manfredi R, Vanzulli A , et al. MR arthrography of the glenohumeral joint: modified posterior approach without imaging guidance. Radiology 2007; 242 (2) 550-554
    CrossrefPubMedGoogle Scholar
  • 13 Porat S, Leupold JA, Burnett KR, Nottage WM. Reliability of non-imaging-guided glenohumeral joint injection through rotator interval approach in patients undergoing diagnostic MR arthrography. AJR Am J Roentgenol 2008; 191 (3) W96-W99
    CrossrefPubMedGoogle Scholar
  • 14 Zwar RB, Read JW, Noakes JB. Sonographically guided glenohumeral joint injection. AJR Am J Roentgenol 2004; 183 (1) 48-50
    CrossrefPubMedGoogle Scholar
  • 15 Mulligan ME. CT-guided shoulder arthrography at the rotator cuff interval. AJR Am J Roentgenol 2008; 191 (2) W58-W61
    CrossrefPubMedGoogle Scholar
  • 16 Soh E, Bearcroft PW, Graves MJ, Black R, Lomas DJ. MR-guided direct arthrography of the glenohumeral joint. Clin Radiol 2008; 63 (12) 1336-1341 ; discussion 1342–1343
    CrossrefPubMedGoogle Scholar
  • 17 Schneider R, Ghelman B, Kaye JJ. A simplified injection technique for shoulder arthrography. Radiology 1975; 114 (3) 738-739
    PubMedGoogle Scholar
  • 18 Chung CB, Dwek JR, Feng S, Resnick D. MR arthrography of the glenohumeral joint: a tailored approach. AJR Am J Roentgenol 2001; 177 (1) 217-219
    CrossrefPubMedGoogle Scholar
  • 19 Dépelteau H, Bureau NJ, Cardinal E, Aubin B, Brassard P. Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval. AJR Am J Roentgenol 2004; 182 (2) 329-332
    CrossrefPubMedGoogle Scholar
  • 20 Farmer KD, Hughes PM. MR arthrography of the shoulder: fluoroscopically guided technique using a posterior approach. AJR Am J Roentgenol 2002; 178 (2) 433-434
    CrossrefPubMedGoogle Scholar
  • 21 de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009; 192 (6) 1701-1707
    CrossrefPubMedGoogle Scholar
  • 22 Waldt S, Bruegel M, Mueller D , et al. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 2007; 17 (2) 491-498
    CrossrefPubMedGoogle Scholar
  • 23 Stetson WB, Phillips T, Deutsch A. The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. J Bone Joint Surg Am 2005; 87 (Suppl 2) 81-88
    CrossrefPubMedGoogle Scholar
  • 24 Meister K, Thesing J, Montgomery WJ, Indelicato PA, Walczak S, Fontenot W. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skeletal Radiol 2004; 33 (3) 136-141
    CrossrefPubMedGoogle Scholar
  • 25 Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology 2002; 224 (2) 470-476
    CrossrefPubMedGoogle Scholar
  • 26 Tirman PF, Bost FW, Steinbach LS , et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology 1994; 192 (3) 851-856
    CrossrefPubMedGoogle Scholar
  • 27 Kassarjian A, Torriani M, Ouellette H, Palmer WE. Intramuscular rotator cuff cysts: association with tendon tears on MRI and arthroscopy. AJR Am J Roentgenol 2005; 185 (1) 160-165
    CrossrefPubMedGoogle Scholar
  • 28 Park YH, Lee JY, Moon SH , et al. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. AJR Am J Roentgenol 2000; 175 (3) 667-672
    CrossrefPubMedGoogle Scholar
  • 29 Chung CB, Corrente L, Resnick D. MR arthrography of the shoulder. Magn Reson Imaging Clin N Am 2004; 12 (1) 25-38 , v–vi
    CrossrefPubMedGoogle Scholar
  • 30 Park YH, Lee JY, Moon SH , et al. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. AJR Am J Roentgenol 2000; 175 (3) 667-672
    CrossrefPubMedGoogle Scholar
  • 31 Massengill AD, Seeger LL, Yao L , et al. Labrocapsular ligamentous complex of the shoulder: normal anatomy, anatomic variation, and pitfalls of MR imaging and MR arthrography. Radiographics 1994; 14 (6) 1211-1223
    CrossrefPubMedGoogle Scholar
  • 32 Bencardino JT, Beltran J. MR imaging of the glenohumeral ligaments. Radiol Clin North Am 2006; 44 (4) 489-502 , vii
    CrossrefPubMedGoogle Scholar
  • 33 Magee T. 3-T MRI of the shoulder: is MR arthrography necessary?. AJR Am J Roentgenol 2009; 192 (1) 86-92
    CrossrefPubMedGoogle Scholar
  • 34 Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary?. AJR Am J Roentgenol 2011; 196 (5) 1139-1144
    CrossrefPubMedGoogle Scholar
  • 35 Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy 1990; 6 (4) 274-279
    CrossrefPubMedGoogle Scholar
  • 36 Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 1995; 23 (1) 93-98
    CrossrefPubMedGoogle Scholar
  • 37 Mohana-Borges AVR, Chung CB, Resnick D. Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. AJR Am J Roentgenol 2003; 181 (6) 1449-1462
    CrossrefPubMedGoogle Scholar
  • 38 Bencardino JT, Beltran J, Rosenberg ZS , et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214 (1) 267-271
    CrossrefPubMedGoogle Scholar
  • 39 Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. AJR Am J Roentgenol 1990; 155 (4) 829-832
    CrossrefPubMedGoogle Scholar
  • 40 Beltran J, Rosenberg ZS, Chandnani VP, Cuomo F, Beltran S, Rokito A. Glenohumeral instability: evaluation with MR arthrography. Radiographics 1997; 17 (3) 657-673
    CrossrefPubMedGoogle Scholar
  • 41 Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol 2004; 182 (5) 1271-1278
    CrossrefPubMedGoogle Scholar
  • 42 Resnick D, Kang HS, Pretterklieber ML. Internal Derangements of Joints. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2007: 889-899
    Google Scholar
  • 43 Beltran J, Bencardino J, Mellado JM, Rosenberg ZS, Irish RD. MR arthrography of the shoulder: variants and pitfalls. Radiographics 1997; 17 (6) 1403-1412 ; discussion 1412–1415
    CrossrefPubMedGoogle Scholar
  • 44 Bresler F, Blum A, Braun M , et al. Assessment of the superior labrum of the shoulder joint with CT-arthrography and MR-arthrography: correlation with anatomical dissection. Surg Radiol Anat 1998; 20 (1) 57-62
    CrossrefPubMedGoogle Scholar
  • 45 Duc SR, Mengiardi B, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Diagnostic performance of MR arthrography after rotator cuff repair. AJR Am J Roentgenol 2006; 186 (1) 237-241
    CrossrefPubMedGoogle Scholar
  • 46 Zanetti M, Jost B, Hodler J, Gerber C. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects. Skeletal Radiol 2000; 29 (6) 314-319
    CrossrefPubMedGoogle Scholar
  • 47 Beltran LS, Morrison WB, Mohana-Borges AVR. The postoperative shoulder. In: Chung CB, Steinbach LS, , eds. MRI of the Upper Extremity: Shoulder, Elbow, Wrist and Hand. Philadelphia, PA: Lippincott; 2010: 367-386
    Google Scholar
  • 48 Sugimoto H, Suzuki K, Mihara K, Kubota H, Tsutsui H. MR arthrography of shoulders after suture-anchor Bankart repair. Radiology 2002; 224 (1) 105-111
    CrossrefPubMedGoogle Scholar
  • 49 Probyn LJ, White LM, Salonen DC, Tomlinson G, Boynton EL. Recurrent symptoms after shoulder instability repair: direct MR arthrographic assessment—correlation with second-look surgical evaluation. Radiology 2007; 245 (3) 814-823
    CrossrefPubMedGoogle Scholar
  • 50 Chung CB, Dwek JR, Cho GJ, Lektrakul N, Trudell D, Resnick D. Rotator cuff interval: evaluation with MR imaging and MR arthrography of the shoulder in 32 cadavers. J Comput Assist Tomogr 2000; 24 (5) 738-743
    CrossrefPubMedGoogle Scholar
  • 51 Morag Y, Jacobson JA, Shields G , et al. MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology 2005; 235 (1) 21-30
    CrossrefPubMedGoogle Scholar
  • 52 Gaskill TR, Braun S, Millett PJ. Multimedia article. The rotator interval: pathology and management. Arthroscopy 2011; 27 (4) 556-567
    CrossrefPubMedGoogle Scholar
  • 53 Charousset C, Bellaïche L, Duranthon LD, Grimberg J. Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br 2005; 87 (6) 824-828
    PubMedGoogle Scholar
  • 54 Lecouvet FE, Simoni P, Koutaïssoff S, Vande Berg BC, Malghem J, Dubuc JE. Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol 2008; 68 (1) 120-136
    CrossrefPubMedGoogle Scholar
  • 55 Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; 304 (304) 78-83
    PubMedGoogle Scholar
  • 56 De Maeseneer M, Boulet C, Pouliart N , et al. Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol 2011; ; February 28 [Epub ahead of print]
    PubMedGoogle Scholar
  • 57 Waldt S, Metz S, Burkart A , et al. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol 2006; 16 (2) 451-458
    CrossrefPubMedGoogle Scholar
  • 58 De Maeseneer M, Van Roy F, Lenchik L , et al. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics 2000; 20 (Spec No) S67-S81
    CrossrefPubMedGoogle Scholar
  • 59 Kim YJ, Choi JA, Oh JH, Hwang SI, Hong SH, Kang HS. Superior labral anteroposterior tears: accuracy and interobserver reliability of multidetector CT arthrography for diagnosis. Radiology 2011; 260 (1) 207-215
    CrossrefPubMedGoogle Scholar
  • 60 Lecouvet FE, Dorzée B, Dubuc JE, Vande Berg BC, Jamart J, Malghem J. Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy. Eur Radiol 2007; 17 (7) 1763-1771
    CrossrefPubMedGoogle Scholar
  • 61 Waldt S, Bruegel M, Ganter K , et al. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol 2005; 15 (4) 784-791
    CrossrefPubMedGoogle Scholar
  • 62 Vande Berg BC, Lecouvet FE, Poilvache P , et al. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Radiology 2002; 222 (2) 430-436
    CrossrefPubMedGoogle Scholar
  • 63 Schmid MR, Pfirrmann CW, Hodler J, Vienne P, Zanetti M. Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol 2003; 32 (5) 259-265
    CrossrefPubMedGoogle Scholar