Zehnder Philipp, Kersten Max, Schwarz Markus, Biberthaler Peter, Kirchhoff Chlodwig, Willinger Lukas
Department of trauma surgery, Technical University of Munich, Munich, Germany.
Department of sport orthopedics, Technical University of Munich, Munich, Germany.
Arch Orthop Trauma Surg. 2025 Sep 12;145(1):447. doi: 10.1007/s00402-025-06062-w.
Shoulder dislocation is the most common major joint dislocation, with anterior dislocations accounting for 95% of cases. Accurate assessment of bony lesions, such as glenoid bone loss (GBL) and Hill-Sachs lesions, is critical for treatment planning. While computed tomography (CT) is the gold standard for evaluating bony parameters, magnetic resonance imaging (MRI) may serve as a viable alternative, offering no radiation exposure. This study aims to compare the reliability of conventional 2D (two- Dimensional)-MRI with 2D-CT in measuring bony parameters and classifying lesions as on- or off-track. It was hypothesized that there is no difference in evaluation between MRI and conventional CT scans.
A retrospective case-control study was conducted on 61 patients (mean age 45 ± 19 years) with anterior shoulder dislocations who underwent both CT and MRI imaging. Radiographic measurements, including glenoid diameter, glenoid defect (in width), Hill-Sachs lesion and bony bridge, were obtained independently from CT and MRI scans. Patients were categorized as on- or off-track based on the glenoid track and Hill-Sachs index. Statistical analyses included correlation tests, Bland-Altman plots, interrater agreement (intraclass correlation coefficient), and sensitivity and specificity analyses for lesion classification.
MRI showed good agreement with CT across most parameters, with mean differences of less than 1 mm for glenoid defect, glenoid diameter, and Hill-Sachs lesions. Correlation coefficients ranged from 0.62 (bony bridge) to 0.93 (glenoid defect). Bland-Altman plots revealed good agreement for glenoid parameters but higher variance for the Hill-Sachs lesion and bony bridge. MRI correctly classified 89% of on-track lesions (sensitivity) and 76% of off-track lesions (specificity). Interrater agreement was excellent for glenoid defect measurements (ICC = 0.962) and lower for the bony bridge (ICC = 0.848).
Conventional MRI demonstrates high reliability in measuring bony parameters and good accuracy in classifying on- and off-track lesions compared to CT. MRI is a viable alternative for preoperative evaluation, particularly in cases with minor bony defects. However, in indeterminate defects, a CT scan is recommended to ensure accurate measurements, classification and treatment planning.
Level III.
肩关节脱位是最常见的大关节脱位，其中前脱位占病例的95%。准确评估骨损伤，如肩胛盂骨缺损（GBL）和希尔-萨克斯损伤，对于治疗方案的制定至关重要。虽然计算机断层扫描（CT）是评估骨参数的金标准，但磁共振成像（MRI）可作为一种可行的替代方法，且无辐射暴露。本研究旨在比较传统二维（2D）MRI与2D-CT在测量骨参数以及将损伤分类为循迹或不循迹方面的可靠性。研究假设MRI与传统CT扫描在评估方面无差异。
对61例（平均年龄45±19岁）接受了CT和MRI成像的前肩关节脱位患者进行了一项回顾性病例对照研究。从CT和MRI扫描中独立获取影像学测量数据，包括肩胛盂直径、肩胛盂缺损（宽度）、希尔-萨克斯损伤和骨桥。根据肩胛盂轨迹和希尔-萨克斯指数将患者分类为循迹或不循迹。统计分析包括相关性检验、布兰德-奥特曼图、评分者间一致性（组内相关系数）以及损伤分类的敏感性和特异性分析。
MRI在大多数参数上与CT显示出良好的一致性，肩胛盂缺损、肩胛盂直径和希尔-萨克斯损伤的平均差异小于1毫米。相关系数范围从0.62（骨桥）到0.93（肩胛盂缺损）。布兰德-奥特曼图显示肩胛盂参数一致性良好，但希尔-萨克斯损伤和骨桥的方差较高。MRI正确分类了89%的循迹损伤（敏感性）和76%的不循迹损伤（特异性）。评分者间对肩胛盂缺损测量的一致性极佳（ICC = 0.962），而对骨桥的一致性较低（ICC = 0.848）。
与CT相比，传统MRI在测量骨参数方面显示出高可靠性，在分类循迹和不循迹损伤方面具有良好的准确性。MRI是术前评估的一种可行替代方法，特别是在骨缺损较小的情况下。然而，对于不确定的缺损，建议进行CT扫描以确保准确测量、分类和治疗方案的制定。
三级。
