Effectiveness of multidetector computed tomography arthrography for the diagnosis of shoulder pathology: comparison with magnetic resonance imaging with arthroscopic correlation.

HYPOTHESIS: This study evaluated the diagnostic efficacy of computed tomography arthrography (CTA) in the assessment of various shoulder pathologies with arthroscopic correlation. We hypothesized that CTA would be cost-effective and effectively comparable with magnetic resonance arthrography (MRA) for assessing labral detachments and full-thickness rotator cuff tears.

MATERIALS AND METHODS: A musculoskeletal radiologist interpreted CTAs for 78 patients and MRAs for 70 patients. Each imaging study was evaluated for the presence of bony (Hill-Sachs) or labral (Bankart or superior labrum anteroposterior [SLAP]) lesions, and rotator cuff disorder (full- or partial-thickness tears). All patients subsequently underwent arthroscopic surgery. Detailed arthroscopic findings were reported and compared with CTA and MRA findings. The sensitivity, specificity, kappa coefficients, and the area under the receiver operating characteristic (AUROC) curve were calculated.

RESULTS: The sensitivity, specificity, and agreement were comparable in each imaging study for Bankart, SLAP, and Hill-Sachs lesions, and full-thickness rotator cuff tears, but those of CTA were significantly lower than MRA for partial-thickness cuff tears. The AUROC curve for CTA and MRA were not significantly different for any of the pathologies, except partial-thickness cuff tears.

CONCLUSIONS: Our data suggest that CTA is a cost-effective, useful method in the preoperative evaluation of labral abnormalities, such as Bankart and SLAP lesions. It may also be useful for the detection of full-thickness rotator cuff tears.

LEVEL OF EVIDENCE: Level I; Diagnostic study.