3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence

Accuracy and Consistency of 3-Dimensional Magnetic Resonance Imaging Is Comparable With 3-Dimensional Computed Tomography in Assessing Glenohumeral Instability: A Systematic Review

PURPOSE

To compare the accuracy of 3-dimensional (3D) magnetic resonance imaging (MRI) with that of 3D computed tomography (CT) in evaluating glenoid bone loss (GBL).

METHODS

This review aligned with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were obtained from data inception to August 28, 2023. The search term "glenoid bone loss" was extracted and analyzed via stringent inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 combined with the QUADAS-Comparative to assess the heterogeneity of included studies.

RESULTS

A total of 1,589 related studies were retrieved, and 10 studies were finally included, of which a total of 143 shoulders were evaluated. The index test in QUADAS-Comparative was low risk in 9 studies. 3D MRI measurements of GBL were primarily best-fit circles (n = 9). In both clinical and cadaveric studies, the mean percentages of GBL measured by 3D MRI were 0.38% to 2.19% and 0.25% to 6.1% when compared with 3D CT and standard reference values, respectively. Intraclass correlation coefficient agreement greater than 0.9 between GBL percentages measured by 3D CT and 3D MRI. 3D MRI also could accurately measure glenoid width, glenoid height, humeral head width, and height. 3D MRI reconstruction time was similar to that of 3D CT, which was mainly 10 to 15 minutes.

CONCLUSIONS

In both clinical and cadaveric studies, compared with 3D CT, 3D MRI is accurate and consistent in assessing glenohumeral bone, especially in measuring GBL, and the reconstruction time of 3D MRI is similar to 3D CT.

LEVEL OF EVIDENCE

Level Ⅲ, systematic review of Level Ⅱ-Ⅲ studies.

Magnetic resonance imaging vs. two- and three-dimensional computed tomography scans for assessment of glenoid inclination and version

Background

Accurate glenoid component placement is crucial for anatomic (aTSA) or reverse (rTSA) total shoulder arthroplasty. Preoperative glenoid assessment in computed tomography (CT) scans with or without planning software seems to be the established method to plan implant positions. Magnetic resonance imaging (MRI) scans can also display the glenoid bone for preoperative assessment while reducing radiation exposure. Therefore, the objective of this study was to manually assess the glenoid version and inclination in 2D MRI and CT scans in cases with degenerative shoulder pathologies. The results were compared to those of an automated 3D planning software to validate the imaging modality for preoperative glenoid assessment.

Methods

MRI and CT scans of 146 patients (n = 41 aTSA; n = 105 rTSA) were included in this retrospective, single-center study. Glenoid version and inclination were measured manually according to Friedman et al and Maurer et al on CT and MRI scans by two observers. Subsequently, the results were compared to the automated measurements performed by planning software. A repeated-measures analysis of variance was performed to compare the measured angles, and the interobserver and intraobserver reliability were calculated using the intraclass correlation coefficients. The level of significance was set at P < .05.

Results

The average glenoid inclination measured in CT scans was 7.94° ± 7.33°, in MRI scans it was 8.56° ± 7.34°, and in automated planning software it was 7.87° ± 7.60°. The analysis of variance revealed significant differences in mean inclination between 2D MRI and 2D CT (P < .0005) and between MRI and automated software (P = .011). No significant difference was found between 2D CT scans and automated planning software (P = 1.000). The mean glenoid version measured in 2D CT scans was -7.94° ± 10.86°, in 2D MRI scans it was -8.04° ± 10.80°, and -8.32° ± 11.53° in the automated planning software. There was no significant difference in between measurement methods (P = .339). Interobserver reliability analysis showed no statistical differences between the two observers. All measurements had excellent intraobserver reliability.

Conclusion

Preoperative assessment of glenoid version and inclination is crucial in ensuring precise implant positioning and orientation in aTSA and rTSA. This study observed a significant level of concordance between manual and automated measuring techniques utilizing MRI and CT scans. The mean glenoid inclination exhibited a statistically significant difference of less than 1° across the assessment modalities, and no difference for glenoid version was noted. It seems to be questionable if this finding is clinically relevant. MRI may serve as a viable and safe option for assessing glenoid morphology, version, and inclination if CT scans are not available.

Use of computed tomography for shoulder arthroplasty: A systematic review

Introduction

The prevalence of total shoulder arthroplasties is on the rise annually. Improvements in implant quality, construct stability, and surgical techniques have notably enhanced post-operative results, prompting an expansion of indications for shoulder arthroplasty. Despite its high success rate, opportunities for enhancement remain, especially in preoperative planning and intraoperative execution. Advanced imaging technologies offer significant potential in optimizing implant placement, thus improving the longevity of the procedure. To our knowledge, a comprehensive review examining the impact of advanced imaging on shoulder arthroplasty has yet to be conducted. This systematic review aims to investigate the benefits of advanced imaging technologies in this context, focusing on their application in preoperative planning, osteoarthritis assessment, intraoperative adjustments, patient-specific instrumentation, and navigational aids.

Methods

This review utilized a comprehensive search of PubMed to identify relevant studies published from 2000 to 2024, focusing on the application of various imaging techniques in shoulder arthroplasty. The search was conducted by two authors and centered on plain radiography, CT scans, and MRI. The selection criteria included availability of full-text articles, English language, direct comparison of imaging techniques, and a focus on patient outcomes, including discussions on broader applications such as intraoperative navigation and patient-specific instrumentation development.

Results

Enhanced imaging techniques, particularly CT scans and MRIs, have been shown to significantly improve outcomes in shoulder arthroplasty. While plain radiographs remain standard, CT scans provide superior bony detail, crucial for evaluating glenoid wear and determining augmentation needs. Preoperative CT imaging has been demonstrated to enhance implant placement accuracy. Moreover, intraoperative technologies based on CT imaging, such as patient-specific instrumentation and navigation systems, contribute to better surgical results.

Conclusion

The benefits of CT imaging in shoulder arthroplasty significantly outweigh the associated costs. Current literature strongly supports the adoption of CT imaging in these procedures, particularly when used alongside modern operative technologies.

Differences in Osseous Shoulder Morphology, Scapulothoracic Orientation, and Muscle Volume in Patients With Constitutional Static Posterior Shoulder Instability (Type C1) Compared With Healthy Controls

BACKGROUND

Constitutional static posterior humeral decentering (type C1 according to ABC Classification) has been recognized as a pre-osteoarthritic deformity that may lead to early-onset posterior decentering osteoarthritis at a young age. Therefore, it is important to identify possible associations of this pathologic shoulder condition to find more effective treatment options.

PURPOSE

To perform a comprehensive analysis of all parameters reported to be associated with a C1 shoulder-including the osseous shoulder morphology, scapulothoracic orientation, and the muscle volume of the shoulder girdle in a single patient cohort.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A retrospective, comparative study was conducted analyzing 17 C1 shoulders in 10 patients who underwent magnetic resonance imaging (MRI) with the complete depiction of the trunk from the base of the skull to the iliac crest, including both humeri. The mean age of the patients was 33.5 years, and all patients were men. To measure and compare the osseous shoulder morphology (glenoid version, glenoid offset, humeral torsion, anterior acromial coverage, posterior acromial coverage, posterior acromial height, and posterior acromial tilt) and scapulothoracic orientation (scapular protraction, scapular internal rotation, scapular upward rotation, scapular translation, scapular tilt, and thoracic kyphosis), these patients were matched 1 to 4 according their age, sex, and affected side with shoulder-healthy patients who had received positron emission tomography (PET)-computed tomography. To measure and compare the muscle volume of the shoulder girdle (subscapularis, infraspinatus/teres minor, supraspinatus, trapezius, deltoid, latissimus dorsi/teres major, pectoralis major, and pectoralis minor), patients were matched 1 to 2 with patients who had received PET-MRI. Patients with visible pathologies of the upper extremities were excluded.

RESULTS

The C1 group had a significantly higher glenoid retroversion, increased anterior glenoid offset, reduced humeral retrotorsion, increased anterior acromial coverage, reduced posterior acromial coverage, increased posterior acromial height, and increased posterior acromial tilt compared with controls (P < .05). Decreased humeral retrotorsion showed significant correlation with higher glenoid retroversion (r = -0.742; P < .001) and higher anterior glenoid offset (r = -0.757; P < .001). Significant differences were found regarding less scapular upward rotation, less scapular tilt, and less thoracic kyphosis in the C1 group (P < .05). The muscle volume of the trapezius and deltoid was significantly higher in the C1 group (P < .05).

CONCLUSION

Patients with C1 shoulders differ from healthy controls regarding osseous scapular and humeral morphology, scapulothoracic orientation, and shoulder girdle muscle distribution. These differences may be crucial in understanding the delicate balance of glenohumeral centering.