PROSPECTIVE EVALUATION OF MR ARTHROGRAPHY PERFORMED WITH HIGH-VOLUME INTRAARTICULAR SALINE ENHANCEMENT IN PATIENTS WITH RECURRENT ANTERIOR DISLOCATIONS OF THE SHOULDER

OBJECTIVE. The purpose of this study was to evaluate the accuracy of h igh-volume saline-enhanced MR arthrography in assessing the labrum, th e ligaments, and the bony components of the glenohumeral joint. SUBJEC TS AND METHODS. Forty-four patients with recurrent anterior dislocatio ns of the shoulder underwent MR arthrography after intraarticular inje ction of 15-40 mi of saline solution. Two-dimensional fast low-angle s hot and T1-weighted spin-echo sequences were prospectively evaluated b y two observers. Anterior (Bankart) lesions, superior labral lesions e xtending from anterior to posterior, and Hill-Sachs lesions were diagn osed. Glenohumeral ligaments (GHLs) were identified and classified usi ng a standard system, MR imaging results were compared with those of a rthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard. RESULTS. Bankart lesions and superior labral lesions ex tending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respecti vely. Diagnostic accuracy was 89% for both types of lesions. All six p atients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging re sults and arthroscopy correlated in 25 of the 31 patients. In three pa tients all three GHLs were visible on MR imaging, but only two GH-Ls w ere detected with arthroscopy. In three patients two GHLs were detecte d on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%. CONCLUSION. High-volume saline-enhanced MR ar thrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint. Saline solution is inert a nd inexpensive, two advantages over gadopentetate dimeglumine.