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Objective To investigate the feasibility of deep learning–based MRI (DL-MRI) in its application in shoulder imaging and compare its performance with conventional MR imaging (non-DL-MRI). Methods This retrospective study was approved by the local ethics committee. Seventy consecutive patients who had been examined with both DL-MRI and non-DL-MRI were enrolled for the image quality and lesion diagnosis comparison. Another 400 patients had been examined only with DL-MRI. Their images’ quality was assessed by 20 radiologists using a satisfaction survey. The Kendall W test was performed to assess interobserver agreement. The Wilcoxon test was performed to compare the image quality. For lesion diagnosis, the interobserver and interstudy agreement were evaluated by kappa analysis. Results The scan time of DL-MRI (6 min 1 s) was nearly 50% decreased compared with that of non-DL-MRI (11 min 25 s). The image quality was higher in both PDWI (4.85 ± 0.31 for DL, and 4.73 ± 0.29 for non-DL) and T2WI (4.95 ± 0.2 for DL, and 4.74 ± 0.41 for non-DL) of DL-MRI. Good interobserver agreement was found for the image quality of all the MR sequences on both DL-MRI (Kendall W : 0.588~0.902) and non-DL-MRI (Kendall W : 0751~0.865). Both the SNRs and |CNR| were significantly higher in PDWI and T2WI of DL-MRI. High interobserver and interstudy agreements for the lesions in non-DL-MRI and DL-MRI (kappa value = 0.913 to 1.000) were observed. The results of the image quality satisfaction survey in 400 patients receiving DL-MRI in the shoulder obtained 5 scores among all the radiologists. Conclusion Shoulder DL-MRI can greatly reduce the scan time, while improve imaging quality of PDWI and T2WI compared to non-DL-MRI. Key Points • Shoulder 2D DL-MRI can greatly reduce the whole scan time and improve imaging quality of both PDWI and T2WI compared to conventional parallel MRI. • Shoulder 2D DL-MRI could be a clinical routine with greatly improved work efficiency in the future.

Now in its Second Edition, this resident-friendly reference explains the basics of MRI...then walks readers easily through the radiologic evaluation of shoulder disorders, particularly rotator cuff disease and shoulder instability. Written in an inviting, easy-to-follow style and illustrated with more than 600 scans, this long-awaited new edition will be a favorite practical reference for residents, practicing radiologists, and orthopaedic surgeons. The book features contributions from expert radiologists and orthopaedic surgeons. Chapters review MRI techniques and shoulder anatomy, describe and illustrate MRI findings for a wide variety of conditions, and explain how abnormalities seen on MR images relate to pathophysiology and clinical signs.

Background: Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears. Purpose: To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities. Results: There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement. Conclusion: An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease.

The definition of the subscapular bursa （SSB） remains controversial.One researcher demonstrated that SSB was a separate pouch.[l] However,others believed that SSB was actually the superior subscapularis recess （SSR）,which is an outpouching of the glenohumeral joint capsule.[4] Whether or not the SSB and SSR are two different bursae must be confirmed.Furthermore,the fluid in the SSR revealed in magnetic resonance （MR） imaging has been regarded as an indication for a diagnosis of frozen shoulder.[3] Considering that the SSB and SSR are two different structures with a close spatial relationship,recognition of the MR appearance of SSB might have important diagnostic implications.The purposes of this study were to describe the anatomy of the SSB using a three-dimensional （3D） visualization technique based on the Chinese visible human （CVH） and to explore the MR appearance of the SSB.

An unusual type of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion in the superior, instead of the usual inferior, part of the anterior glenoid labrum is presented in a 33‐year‐old man who sustained a traumatic dislocation of his left shoulder. Magnetic resonance imaging raised the possibility of an ALPSA lesion and later arthroscopy confirmed the diagnosis. Arthroscopic repair of the lesion was performed after the labral avulsion was lateralized.

Objective To determine whether 3D-MR osseous reformats of the shoulder are equivalent to 3D-CT osseous reformats in patients with glenohumeral instability. Materials and methods Patients with glenohumeral instability, who were to be imaged with both CT and MRI, were prospectively selected. CT and MR were performed within 24 h of one another on 12 shoulders. Each MR study included an axial 3D isotropic VIBE sequence. The image data from the isotropic VIBE sequence were post-processed using subtraction and 3D software. CT data were post-processed using 3D software. The following measurements were obtained for both 3D-CT and 3D-MR post-processed images: height and width of the humeral head and glenoid, Hill-Sachs size and percent humeral head loss (if present), size of glenoid bone loss and percent glenoid bone loss (if present). Paired t-tests and two one-sided tests for equivalence were used to assess the differences between imaging modalities and equivalence. Results The measurement differences from the 3D-CT and 3D-MR post-processed images were not statistically significant. The measurement differences for humeral height, glenoid height and glenoid width were borderline statistically significant; however, using any adjustment for multiple comparisons, this failed to be significant. Using an equivalence margin of 1 mm for measurements and 1.5% for percent bone loss, the 3D-MR and 3D-CT post-processed images were equivalent. Conclusion Three-dimensional-MR osseous models of the shoulder using a 3D isotropic VIBE sequence were equivalent to 3D-CT osseous models, and the differences between modalities were not statistically significant.

ObjectivesTo perform a systematic review and meta-analysis to identify magnetic resonance imaging (MRI) features that will aid in the diagnosis of adhesive capsulitis of the shoulder (ACS) and provide a summary of the diagnostic accuracy of the identified featuresMethodsThe MEDLINE and EMBASE databases were searched for studies assessing the diagnostic accuracy of MRI features of ACS. Overlapping descriptors used to denote the same imaging finding in different studies were subsumed under a single feature. The pooled accuracy including the diagnostic odd ratios (DORs) with 95% confidence intervals (CIs) of the identified features was calculated using a bivariate random-effects model.ResultsIn total, 15 studies were included, and 74 overlapping descriptors were subsumed under six features. All six features were found to be informative for ACS diagnosis [coracohumeral ligament thickening: DOR, 13; 95% CI, 6-29; fat obliteration of the rotator interval (RI): DOR, 8; 95% CI, 3-24; RI enhancement: DOR, 44; 95% CI, 14-141; axillary joint capsule enhancement: DOR, 52; 95% CI, 27-98; inferior glenohumeral ligament (IGHL) hyperintensity: DOR, 31; 95% CI, 8-115; IGHL thickening: DOR, 28; 95% CI, 11-70]. The sensitivity and specificity of enhancement of the RI and axillary joint capsule and IGHL hyperintensity were > 80%.ConclusionsSix informative MRI features for ACS diagnosis were identified in this study with RI and axillary joint capsule enhancement and IGHL hyperintensity showing the highest diagnostic accuracy. Informative features observed on non-arthrogram MRI can be as helpful as features observed on direct magnetic resonance arthrography for ACS diagnosis.Key points• Six informative MRI features for ACS diagnosis were identified (diagnostic odds ratio > 1).• RI and axillary joint capsule enhancement and IGHL hyperintensity showed high sensitivities/specificities (> 80%).• The use of non-arthrogram MRI is recommended for ACS diagnosis.

Objective Although SLAP-5 lesions are associated with recurrent dislocations, their causes and pathomechanisms have not been fully elucidated. This study aimed to investigate the association between SLAP-5 lesions and scapular morphology in traumatic anterior shoulder instability (ASI). We hypothesized that there may be a relationship between SLAP-5 lesions and scapular morphology in traumatic ASI patients. Materials and methods The study included 74 patients with isolated Bankart lesions and 69 with SLAP-5 lesions who underwent arthroscopic labral repair for ASI. Critical shoulder angle (CSA) was measured on the roentgenograms, while glenoid inclination (GI) and glenoid version (GV) were measured on magnetic resonance imaging (MRI) by two observers in two separate sessions blinded to each other. Both groups were compared in terms of CSA, GI, and GV. Results The mean ages of Bankart and SLAP-5 patients were 28.4±9.1 and 27.9±7.7 ( P =0.89), respectively; their mean CSA values were 33.1°±2.6° and 28.2°±2.4°, respectively ( P <0.001). The ROC analysis’s cut-off value was 30.5°, with 75.0% sensitivity and 76.7% specificity (AUC = 0.830). SLAP-5 lesions were more common on the dominant side than isolated Bankart lesions ( P =0.021), but no difference was found between the groups in terms of GI and GV ( P =0.334, P =0.081, respectively). Conclusions In ASI, low CSA values appeared to be related to SLAP-5 lesions, and the cut-off value of CSA for SLAP lesion formation was 30.5° with 75.0% sensitivity and 76.7% specificity. Scapula morphology may be related to the SLAP-5 lesions, and CSA can be used as an additional parameter in provocative diagnostic tests and medical imaging techniques for the detection of SLAP lesions accompanying Bankart lesions. Level of Evidence III retrospective case-control study

To investigate and compare the values of 3.0 T MRI T1, T2 and T2* mapping quantification techniques in evaluating cartilage degeneration of the shoulder joint. This study included 123 shoulder joints of 119 patients, which were scanned in 3.0 T MRI with axial Fat Suppression Proton Density Weighted Image (FS-PDWI), sagittal fat suppression T2 Weighted Image (FS-T2WI), coronal T1Weighted Image (T1WI), FS-PDWI, cartilage-specific T1, T2 and T2* mapping sequences. Basing on MRI images, the shoulder cartilage was classified into grades 0 1, 2, 3 and 4 according to the International Cartilage Regeneration & Joint Preservation Society (ICRS). The grading of shoulder cartilage was based on MRI images with ICRS as reference, and did not involve arthroscopy or histology.The T1, T2 and T2* relaxation values in the superior, middle and inferior bands of shoulder articular cartilage were measured at all grades, and the differences in various indicators between groups were analyzed and compared using a single-factor ANOVA test. The correlation between T1, T2 and T2* relaxation values and MRI-based grading was analyzed by SPSS software. There were 46 shoulder joints with MRI-based grade 0 in healthy control group (n = 46), while 49 and 28 shoulder joints with grade 1–2 (mild degeneration subgroup) and grade 3–4 (severe degeneration subgroup) in patient group (n = 73), accounting for 63.6% and 36.4%, respectively. The T1, T2 and T2* relaxation values of the superior, middle and inferior bands of shoulder articular cartilage were significantly and positively correlated with the MRI-based grading ( P  < 0.01). MRI-basedgrading of shoulder cartilage was markedly associated with age (r = 0.766, P  < 0.01). With the aggravation of cartilage degeneration, T1, T2 and T2* relaxation values showed an upward trend (all P  < 0.01), and T1, T2 and T2* mapping could distinguish cartilage degeneration at all levels (all P  < 0.01). The T1, T2 and T2* relaxation values were significantly different between normal group and mild degeneration subgroup, normal group and severe degeneration subgroup, mild degeneration subgroup and severe degeneration subgroup (all P  < 0.05). Quantitative T1, T2 and T2* mapping can quantify the degree of shoulder cartilage degeneration. All these MRI mapping quantification techniques can be used as critical supplementary sequences to assess shoulder cartilage degeneration, among which T2 mapping has the highest value.

Objectives The objective of this study is to prospectively assess the effectiveness of shoulder magnetic resonance (MR) arthrograms with positional manoeuvres in detecting posterior synovial folds. Methods Two radiologists independently assessed all axial MR arthrograms in internal rotation, neutral position, and external rotation for the presence of a posterior synovial fold. The diagnostic performances of the MR arthrograms were then compared, with results validated through arthroscopy. Results Arthroscopy was performed on 81 of the 150 patients included in the study. A posterior synovial fold was identified arthroscopically in eleven of these patients. Measurements of the posterior synovial fold obtained in external rotation and the neutral position of the arm showed a significant correlation with arthroscopic results ( p  < 0.05). For detecting the posterior synovial fold with arthroscopic correlation, the sensitivity and specificity values for observer 1 and observer 2 were 100–81.4% and 100–88.6%, respectively, for MR arthrograms in the neutral position; 100–52.9% and 100–62.9% for MR arthrograms in external rotation; and 100–95.7% and 81.8–98.6% for MR arthrograms in internal rotation. There was a fair agreement for MR arthrography in external rotation for detecting posterior synovial folds, while MR arthrograms in internal rotation and neutral position showed near-perfect and significant interobserver agreement. Conclusion The rotational positions of the humeral neck during MR arthrographic examination can influence the diagnostic specificity and sensitivity of axial MR arthrograms in detecting the posterior synovial fold. Clinical relevance statement The posterior synovial fold can mimic a posterior labral detachment. Therefore, its correct identification is crucial in order to avoid unnecessary surgical procedures. Key Points Movement of the shoulder may introduce variability in MR arthrography appearance . Rotation of the humeral neck during MR arthrography can affect diagnoses in posterior synovial fold detection . Given that posterior synovial folds can imitate posterior labral detachment, their correct identification is crucial to avoid unnecessary surgical procedures .