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CT arthrography may be preferred modality for assessing shoulder instability compared to MRA

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MADRID — The use of CT arthrography was found to be more sensitive to picking up on bony lesions than magnetic resonance imaging arthrography in an investigation presented here.

“The study we conducted was to compare CT and MRA used in patients with shoulder instability,” Qasim Ajmi, an orthopaedic registrar from London said. His comments came during the EFORT Congress 2010.

Seeing in the soft tissue window

MRI arthrography (MRA) is commonly used in the investigation of shoulder instability, he reported “However many surgeons are now using CT arthrography (CTA) as their primary radiological investigative modality. They argue that CTA is cheaper, and give satisfactory soft tissue images in the ‘soft tissue window.’”

For the comparison, Ajmi and colleagues reviewed the operative and arthrographic findings in all patients who had surgery for shoulder instability in their unit during a 4-year period. They compared the results of the CTAs with the definitive findings found at the time of surgery, according to the study abstract.

All CTAs were performed by standard techniques and were reported by musculoskeletal radiology consultants and all surgery was performed by experienced consultant shoulder surgeons, he said.

One difference

In total 48 CTAs and 50 MRAs were performed. The investigators found that there was no significant difference between the two modalities when looking at labral pathology. However they found the CTAs were significantly more sensitive at picking up bony lesions, Ajmi said.

“CTAs picking up the bony pathologies can help a surgeon make the decision between open and arthroscopic surgery,” he said.

“We found that the CTA was more sensitive and more predictive in deciding which surgical modality should be performed,” Ajmi said.

• Reference:

  Sivardeen Z, Ajmi Q, Thiagarajah S, et al. MRI or CT arthrography for the investigation of shoulder instability: Whish is the better modality? Paper #F492. Presented at EFORT Congress 2010. June 2-5, 2010. Madrid.