Skip to main content
SpringerLink
Log in

A comparison of saline and gadolinium shoulder MR arthrography to arthroscopy

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Compare the diagnostic performance of saline and gadolinium shoulder magnetic resonance arthrograms (MRA) in the detection of labral and rotator cuff injury compared to arthroscopy.

Materials and methods

Consecutive patients who underwent a gadolinium or saline MRA followed by arthroscopy were retrospectively reviewed. The reports were reviewed for injuries. A chi square or Fisher’s exact test was performed to compare the MRA and surgery. Kappa values were calculated to correlate diagnosis of tear between MRA and arthroscopy.

Results

There were a total of 58 patients included, including 34 gadolinium arthrograms and 24 saline arthrograms. The accuracy of saline MRA was similar compared to gadolinium MRA in the diagnosis of tears of the supraspinatus (accuracy 0.88 vs 0.74, respectively) and infraspinatus (accuracy 0.88 vs 0.65, respectively) tendons and tears of the anterior/anterior inferior, posterior, and superior labrum, (accuracy 0.79 vs 0.76, 0.71 vs 0.62, and 0.58 vs 0.56), and saline vs gadolinium, respectively. Although there was a trend toward overall better saline MRA performance, a statistically significant difference in the accuracy to detect tears was only noted for the infraspinatus tendon. Interobserver agreement for rotator cuff tears was higher for saline than gadolinium MRA.

Conclusion

Saline MRA was accurate, with no significant differences compared gadolinium arthrograms in the diagnosis of labral and rotator cuff pathology. Given expense, and the potential additional information provided by fluid sensitive sequences over T1 fat-suppressed sequences, consideration should be given to using saline for shoulder MRAs.

Level of Evidence

Level III, Retrospective Cohort Study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

MRA:

Magnetic resonance arthrography

SLAP:

Superior labral anterior to posterior

References

  1. Hodler J, Kursunoglu-Brahme S, Snyder SJ, et al. Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. Radiology. 1992;182:431–6.

    Article  CAS  Google Scholar 

  2. Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. Am J Roentgenol. 1990;155:829–32.

    Article  CAS  Google Scholar 

  3. Magee T, Williams D, Mani N. Shoulder MR arthrography: which patient group benefits most? Am J Roentgenol. 2004;183:969–74.

    Article  Google Scholar 

  4. 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. Am J Roentgenol. 2009;192:1701–7.

    Article  Google Scholar 

  5. Smith TO, Drew BT, Toms AP. A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury. Arch Orthop Trauma Surg. 2012;132:905–19.

    Article  Google Scholar 

  6. Tuite MJ. Magnetic resonance imaging of rotator cuff disease and external impingement. Magn Reson Imaging Clin N Am. 2012;20:187–200.

    Article  Google Scholar 

  7. Ricchetti ET, Ciccotti MC, Ciccotti MG, Williams GR, Lazarus MD. Sensitivity of preoperative magnetic resonance imaging and magnetic resonance arthrography in detection of Panlabral tears of the Glenohumeral joint. Arthroscopy. 2013;29:274–9.

    Article  Google Scholar 

  8. McGarvey C, Harb Z, Smith C, Houghton R, Corbett S, Ajuied A. Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis. Skelet Radiol. 2016;45:251–61.

    Article  Google Scholar 

  9. Zanetti M, Hodler J. Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results. Eur Radiol. 1997;7:498–502.

    Article  CAS  Google Scholar 

  10. Nacey NC, Fox MG, Bertozzi CJ, Pierce JL, Said N, Diduch DR. Incidence of gadolinium or fluid signal within surgically proven glenoid labral tears at MR arthrography. Skelet Radiol. 2019;48:1185–91.

    Article  Google Scholar 

  11. Helms CA, McGonegle SJ, Vinson EN, Whiteside MB. Magnetic resonance arthrography of the shoulder: accuracy of gadolinium versus saline for rotator cuff and labral pathology. Skelet Radiol. 2011;40:197–203.

    Article  Google Scholar 

  12. Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. RadioGraphics. 2002;22:1223–46.

    Article  Google Scholar 

  13. Hajek PC, Sartoris DJ, Neumann CH, Resnick D. Potential contrast agents for MR arthrography: in vitro evaluation and practical observations. Am J Roentgenol. 1987;149:97–104.

    Article  CAS  Google Scholar 

  14. Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304:1491–4.

    Article  CAS  Google Scholar 

  15. Wilk KE, Reinold MM, Dugas JR, Arrigo CA, Moser MW, Andrews JR. Current concepts in the recognition and treatment of superior labral (SLAP) lesions. J Orthop Sports Phys Ther. 2005;35:273–91.

    Article  Google Scholar 

  16. Pappas ND, Hall DC, Lee DH. Prevalence of labral tears in the elderly. J Shoulder Elb Surg. 2013;22:e11–5.

    Article  Google Scholar 

  17. Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulders. Orthop J Sports Med. 2016;4:2325967115623212.

    Article  Google Scholar 

  18. Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol. 2017;16:564–70.

    Article  Google Scholar 

  19. McDonald RJ, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology. 2015;275:772–82.

    Article  Google Scholar 

  20. Guo BJ, Yang ZL, Zhang LJ. Gadolinium deposition in brain: current scientific evidence and future perspectives. Front Mol Neurosci. 2018;11:335.

    Article  Google Scholar 

  21. Darrah TH, Prutsman-Pfeiffer JJ, Poreda RJ, Ellen Campbell M, Hauschka PV, Hannigan RE. Incorporation of excess gadolinium into human bone from medical contrast agents. Metallomics. 2009;1:479–88.

    Article  CAS  Google Scholar 

  22. Kralik SF, Singhal KK, Frank MS, Ladd LM. Evaluation of gadolinium deposition in the brain after MR arthrography. Am J Roentgenol. 2018;211:1063–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA

    Adam D. Singer, Jeffrey Rosenthal, Monica Umpierrez & Felix Gonzalez

  2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia

    Yi Guo

  3. Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, Georgia

    Eric Wagner

Authors
  1. Adam D. Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Umpierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Felix Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam D. Singer.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singer, A.D., Rosenthal, J., Umpierrez, M. et al. A comparison of saline and gadolinium shoulder MR arthrography to arthroscopy. Skeletal Radiol 49, 625–633 (2020). https://doi.org/10.1007/s00256-019-03338-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-019-03338-2

Keywords

Search

Navigation