MRA vs Arthroscopy 2
Rukhtam Saqib, Joanthan Harris, Lennard Funk
Shoulder arthroscopy is the established gold standard diagnostic investigation for detecting shoulder pathology. The use of magnetic resonance arthrography (MRA) of the shoulder has increased. We assessed the the diagnostic accuracy of MRA, as compared with arthroscopy for the detection of shoulder pathologies in patients with shoulder instability.
We reviewed 194 consecutive patients over a one year period. MRA and arthroscopy reports were used to identify labral tears, anterior labral tears, SLAP lesions, posterior labral tears, rotator cuff tears, osteoarthritis, loose bodies and Hill-Sach's's lesions. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios were calculated.
The sensitivity/specificity findings were:
- Anterior labral tears - 0.60/0.92
- SLAP lesions - 0.75/0.81
- Posterior labral tears - 0.57/0.96
- Any labral tear - 0.87/0.76
- Hill-Sach's lesion - 0.91/0.91
- Rotator cuff tears - 0.71/0.86
- Osteoarthritis - 0.72/0.95
- Loose bodies - 0.22/0.96
- Anterior labral tears - 0.88/0.71
- SLAP lesions - 0.64/0.88
- Posterior labral tears - 0.74/0.45
- Any labral tear - 0.89/0.71
- Hill-Sach's lesion - 0.66/0.98
- Rotator cuff tears - 0.47/0.95
- Osteoarthritis - 0.70/0.95
- Loose bodies - 0.27/0.95
MRA is a useful diagnostic tool for clinicians with high diagnostic accuracy for labral tears and Hill-Sach's lesions. Our data is comparable to previous published studies. The importance of imaging preoperatively for surgical planning remains but whether MRA should be the prime modality is debatable.