OBJECTIVE:To evaluate the diagnostic yield of two acquisitions of single-contrast CT arthrography (CTA) of the shoulder in internal, neutral, or external glenohumeral rotation with arthroscopic correlation. MATERIALS AND METHODS:The CT study was obtained using two acquisitions (first the humerus positioned in maximum tolerated external rotation with the arm along the body and the second with the humerus in internal rotation with the palm placed flat on the table). Two independent readers blinded to the arthroscopic results evaluated the CTA images for labral tears, glenoid bone loss/fractures, and cartilage loss. For each CTA acquisition, sensitivity and specificity for detection of the aforementioned pathology were assessed. Inter-reader agreement was quantified by weighted ĸ statistics. RESULTS:Sensitivity and specificity for detecting anteroinferior or posterior labral tears was highest with neutral rotation (sensitivity 91-100%, specificity 61-100%). For glenoid fracture, sensitivity (67%) was highest with external rotation and specificity (100%) was highest with internal rotation. For cartilage loss, sensitivity (64%) and specificity (89%) was highest with external rotation and neutral rotation, respectively. Neutral rotation showed high sensitivity and specificity for glenoid fractures and cartilage loss. Inter-reader agreement ranged from fair to very good. CONCLUSIONS:Neutral glenohumeral position in shoulder CT arthrography was adequately sensitive and specific for the detection of intra-articular pathology, avoiding the use of more than one acquisition.

译文

目的:通过关节镜相关性评估两次获取的单次CT单次CT造影(CTA)在内部,中性或外部盂肱旋转中的诊断价值。
材料与方法:CT研究是通过两次采集获得的(首先,肱骨在手臂沿身体的最大允许外旋中定位,第二步在肱骨内旋转且手掌平放在桌子上的状态下进行肱骨旋转)。两名不愿接受关节镜检查结果的独立读者评估了CTA图像的唇裂,盂盂骨丢失/骨折和软骨丢失。对于每次CTA采集,评估用于检测上述病理的敏感性和特异性。读者间的一致性通过加权统计来量化。
结果:中性旋转时,检出前下唇或后唇撕裂的敏感性和特异性最高(敏感性为91-100%,特异性为61-100%)。对于关节盂骨折,外旋敏感性最高(67%),内旋特异性最高(100%)。对于软骨损失,外旋和中性旋转分别具有最高的敏感性(64%)和特异性(89%)。中性旋转显示出对关节盂骨折和软骨损失的高敏感性和特异性。读者间的协议范围从公平到非常好。
结论:肩部CT关节造影中的肱骨肱中位对于检测关节内病变具有足够的敏感性和特异性,避免了多次采集。

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