Palmer W E, Caslowitz P L
Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
Radiology. 1995 Dec;197(3):819-25. doi: 10.1148/radiology.197.3.7480762.
To determine magnetic resonance (MR) arthrographic criteria in the diagnosis of anterior glenohumeral instability.
In 121 patients with diagnoses proved surgically, the labrum, glenohumeral ligaments, and capsular insertion types were assessed prospectively with gadolinium-enhanced MR arthrography. Findings were compared in stable and unstable shoulders.
Operative results showed 59 normal, 57 torn, and five deficient labra. In 37 unstable shoulders, 31 had discrete inferior labral-ligamentous lesions and six had capsular laxity. MR arthrograms showed labral abnormalities with 92% sensitivity, 92% specificity. Inferior labral-ligamentous lesions enabled prediction of anterior instability with 76% sensitivity (capsular laxity was missed in all shoulders), 98% specificity. Inferior labral-ligamentous abnormalities were strongly associated with unstable shoulders (P << .0001), whereas noninferior labral-ligamentous abnormalities were related to stable shoulders (P = .01). Capsular insertion types showed no significant differences between stable and unstable shoulders (P > .8).
On MR arthrograms, inferior labral-ligamentous abnormalities were most closely correlated with anterior glenohumeral instability. Capsular insertion sites had no role in the prediction of shoulder instability.
确定磁共振（MR）关节造影在诊断盂肱关节前向不稳中的标准。
对121例经手术证实诊断的患者，采用钆增强MR关节造影对盂唇、盂肱韧带和关节囊附着类型进行前瞻性评估。对稳定和不稳定肩关节的检查结果进行比较。
手术结果显示，59例盂唇正常，57例盂唇撕裂，5例盂唇缺损。在37例不稳定肩关节中，31例有离散的下盂唇韧带损伤，6例有关节囊松弛。MR关节造影显示盂唇异常的敏感度为92%，特异度为92%。下盂唇韧带损伤对前向不稳的预测敏感度为76%（所有肩关节均未发现关节囊松弛），特异度为98%。下盂唇韧带异常与不稳定肩关节密切相关（P << 0.0001），而非下盂唇韧带异常与稳定肩关节相关（P = 0.01）。关节囊附着类型在稳定和不稳定肩关节之间无显著差异（P > 0.8）。
在MR关节造影上，下盂唇韧带异常与盂肱关节前向不稳的相关性最强。关节囊附着部位对肩关节不稳的预测无作用。
