Walter William R, Samim Mohammad, LaPolla Fred Willie Zametkin, Gyftopoulos Soterios
Department of Radiology, Musculoskeletal Division, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003.
New York University Health Sciences Library, New York University, New York, NY.
AJR Am J Roentgenol. 2019 May;212(5):1096-1105. doi: 10.2214/AJR.18.20504. Epub 2019 Mar 5.
To listen to the podcast associated with this article, please select one of the following: iTunes, Google Play, or direct download. The purpose of this study is to determine the most accurate imaging techniques to measure glenoid bone loss in anterior glenohumeral instability through a systematic review of existing literature. We performed a comprehensive literature search of five databases for original research measuring glenoid bone loss at radiography, CT, or MRI, using prospective or retrospective cohort, case-control, or cadaveric study designs up to January 2018. The Quality Assessment of Diagnostic Accuracy Studies-2 tool aided qualitative assessment of the methods. Data extraction included results, index test interobserver agreement, and accuracy analysis. Twenty-seven studies (evaluating 1425 shoulders) met inclusion criteria after full-text review by two independent readers. Glenoid bone loss was assessed, comparing several index tests to nonimaging ( = 18 studies) and imaging ( = 11) reference standards. Compared with arthroscopic or cadaveric measurements, 2D CT was accurate in six of seven studies (86%), 3D CT was accurate in eight of 10 studies (80%), 2D MRI was accurate in five of seven studies (71%), 3D MRI was accurate in four of four studies (100%), and radiographs were accurate in zero of four studies (0%). Best-fit circle methods (glenoid width or Pico surface area) were the most common and both were accurate (86-90% and 75-100%, respectively) using CT and MRI. Studies had good external validity (78%). Most risk for bias arose from patient selection and reference standards. Only two studies reported sensitivity and specificity, both comparing CT to arthroscopy using different bone loss thresholds (20% and 25%). CT and MRI (2D or 3D) accurately measure glenoid bone loss in anterior shoulder instability, but radiographs do not. Best-fit circle measurement techniques are reliable and accurate. Current literature about glenoid bone loss is heterogeneous, and future studies should focus on diagnosis of clinically relevant glenoid bone loss.
若要收听与本文相关的播客，请选择以下选项之一：iTunes、谷歌Play或直接下载。本研究的目的是通过对现有文献的系统回顾，确定测量前盂肱关节不稳时盂骨缺损的最准确成像技术。我们对五个数据库进行了全面的文献检索，以查找采用前瞻性或回顾性队列研究、病例对照研究或尸体研究设计，在X线摄影、CT或MRI上测量盂骨缺损的原始研究，检索截至2018年1月。诊断准确性研究质量评估-2工具辅助对方法进行定性评估。数据提取包括结果、索引测试的观察者间一致性以及准确性分析。经过两名独立读者的全文审查，27项研究（评估1425个肩部）符合纳入标准。对盂骨缺损进行了评估，将几种索引测试与非成像（n = 18项研究）和成像（n = 11项研究）参考标准进行比较。与关节镜或尸体测量相比，二维CT在7项研究中的6项（86%）中准确，三维CT在10项研究中的8项（80%）中准确，二维MRI在7项研究中的5项（71%）中准确，三维MRI在4项研究中的4项（100%）中准确，而X线片在4项研究中的0项（0%）中准确。最佳拟合圆方法（盂宽度或皮科表面积）最为常见，使用CT和MRI时两者均准确（分别为86 - 90%和75 - 100%）。研究具有良好的外部效度（78%）。大多数偏倚风险来自患者选择和参考标准。只有两项研究报告了敏感性和特异性，均使用不同的骨缺损阈值（20%和25%）将CT与关节镜检查进行比较。CT和MRI（二维或三维）能准确测量前肩不稳时的盂骨缺损，但X线片不能。最佳拟合圆测量技术可靠且准确。目前关于盂骨缺损的文献参差不齐，未来的研究应聚焦于临床相关盂骨缺损的诊断。
