ORIGINAL ARTICLE Virtual MR arthroscopy of the shoulder: image gallery with arthroscopic correlation of major pathologies in shoulder instability A. Stecco Æ D. Volpe Æ N. Volpe Æ P. Fornara Æ A. Castagna Æ A. Carriero Received: 8 October 2007 / Accepted: 19 August 2008 / Published online: 7 October 2008 Ó Springer-Verlag 2008 Abstract Background The purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well- assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology. Materials and methods We enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa— before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radi- ologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images. Results These images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings. Conclusions Although in our pilot study the VA find- ings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images. Keywords 3D MR imaging Á Magnetic resonance Á MR arthrography Á Virtual MR arthrography Introduction MR arthrography (MR-AR) is now considered the gold- standard of radiology in the evaluation of shoulder instability. In patients with such a condition, MR-AR allows an accurate assessment of: capsulolabral complex, undersur- face of the rotator cuff (RC), glenohumeral ligaments and RC interval [1]; moreover, the technique also gives infor- mation on eventual glenoid and humeral bone loss, for which computed tomography (CT) is the standard of reference. The rationale of this technique is the capsular disten- tion. This allows distinction of individual structures by improved soft-tissue contrast and physical separation obtained by the intra-articular contrast material, and allows an analysis of the distribution of contrast material ‘‘in’’ and ‘‘around’’ the joint. The combination of administration of paramagnetic contrast with a fast gra- dient-echo 3D T1w (SPGR 3D T1) pulse sequence provides a new method for displaying vascular and intestinal morphology [2–6]. Based on the same A. Stecco (&) Á D. Volpe Á N. Volpe Á A. Carriero Department of Radiology, Maggiore della Carita ` Hospital, Eastern Piedmont University, Novara, Italy e-mail: [email protected]P. Fornara Department of Orthopaedic Surgery, Maggiore della Carita ` Hospital, Corso Mazzini 18, Novara, Italy A. Castagna Department of Orthopaedic Surgery, Istituto Clinico Humanitas, Milan, Italy 123 J Orthopaed Traumatol (2008) 9:187–193 DOI 10.1007/s10195-008-0027-1
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ORIGINAL ARTICLE
Virtual MR arthroscopy of the shoulder: image gallerywith arthroscopic correlation of major pathologiesin shoulder instability
A. Stecco Æ D. Volpe Æ N. Volpe Æ P. Fornara ÆA. Castagna Æ A. Carriero
Received: 8 October 2007 / Accepted: 19 August 2008 / Published online: 7 October 2008
� Springer-Verlag 2008
Abstract
Background The purpose of this study was to compare
virtual MR arthroscopic reconstructions with arthroscopic
images in patients affected by shoulder joint instability.
MR arthrography (MR-AR) of the shoulder is now a well-
assessed technique, based on the injection of a contrast
medium solution, which fills the articular space and finds
its way between the rotator cuff (RC) and the glenohumeral
ligaments. In patients with glenolabral pathology, we used
an additional sequence that provided virtual arthroscopy
(VA) post-processed views, which completed the MR
evaluation of shoulder pathology.
Materials and methods We enrolled 36 patients, from
whom MR arthrographic sequence data (SE T1w and GRE
T1 FAT SAT) were obtained using a GE 0.5 T Signa—
before any surgical or arthroscopic planned treatment; the
protocol included a supplemental 3D, spoiled GE T1w
positioned in the coronal plane. Dedicated software loaded
on a work-station was used to elaborate VAs. Two radi-
ologists evaluated, on a semiquantitative scale, the
visibility of the principal anatomic structures, and then, in
consensus, the pathology emerging from the VA images.
Results These images were reconstructed in all patients,
except one. The visualization of all anatomical structures
was acceptable. VA and MR arthrographic images were
fairly concordant with intraoperative findings.
Conclusions Although in our pilot study the VA find-
ings did not change the surgical planning, the results
showed concordance with the surgical or arthroscopic
images.
Keywords 3D MR imaging � Magnetic resonance �MR arthrography � Virtual MR arthrography
Introduction
MR arthrography (MR-AR) is now considered the gold-
standard of radiology in the evaluation of shoulder
instability.
In patients with such a condition, MR-AR allows an
accurate assessment of: capsulolabral complex, undersur-
face of the rotator cuff (RC), glenohumeral ligaments and
RC interval [1]; moreover, the technique also gives infor-
mation on eventual glenoid and humeral bone loss, for
which computed tomography (CT) is the standard of
reference.
The rationale of this technique is the capsular disten-
tion. This allows distinction of individual structures by
improved soft-tissue contrast and physical separation
obtained by the intra-articular contrast material, and
allows an analysis of the distribution of contrast material
‘‘in’’ and ‘‘around’’ the joint. The combination of
administration of paramagnetic contrast with a fast gra-
dient-echo 3D T1w (SPGR 3D T1) pulse sequence
provides a new method for displaying vascular and
intestinal morphology [2–6]. Based on the same
A. Stecco (&) � D. Volpe � N. Volpe � A. Carriero
Department of Radiology, Maggiore della Carita Hospital,