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Sensitivity and Specificity of Noncontrast Magnetic Resonance Imaging Reports in the Diagnosis of Type-II Superior Labral Anterior-Posterior Lesions in the Community Setting
Keith P. Connolly, BS1; Randy S. Schwartzberg, MD2; Bryan Reuss, MD2; David Crumbie, Jr, MD3; Brad M. Homan, DO3
1 University of Central Florida College of Medicine, 531 Canary Island Court, Orlando, FL 32828. E-mail address: kconnolly@knights.ucf.edu
2 Orlando Orthopaedic Center, 25 West Crystal Lake Street, Suite 200, Orlando, FL 32806. E-mail address for R.S. Schwartzberg: orlandosportsdoc@yahoo.com
3 Celebration Orthopaedics and Sports Medicine Institute, 410 Celebration Place, Suite 106, Celebration, FL 34747. E-mail address for B.M. Homan: brad.homan.do@flhosp.org
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A commentary by Jon K. Sekiya, MD, is linked to the online version of this article at jbjs.org.

Investigation performed at the Orlando Orthopaedic Center, Orlando, and Celebration Orthopaedics and Sports Medicine Institute, Celebration, Florida

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Feb 20;95(4):308-313. doi: 10.2106/JBJS.K.01115
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Magnetic resonance imaging (MRI) has been suggested to be of high accuracy at academic institutions in the identification of superior labral tears; however, many Type-II superior labral anterior-posterior (SLAP) lesions encountered during arthroscopy have not been previously diagnosed with noncontrast images. This study evaluated the accuracy of diagnosing Type-II SLAP lesions in a community setting with use of noncontrast MRI and analyzed the effect that radiologist training and the scanner type or magnet strength had on sensitivity and specificity.


One hundred and forty-four patients requiring repair of an arthroscopically confirmed Type-II SLAP lesion who had a noncontrast MRI examination performed within twelve months before the procedure were included in the sensitivity analysis. An additional 100 patients with arthroscopically confirmed, normal superior labral anatomy were identified for specificity analysis. The transcribed interpretations of the images by the radiologists were used to document the diagnosis of a SLAP lesion and were compared with the operative report. The magnet strength, type of MRI system (open or closed), and whether the radiologist had completed a musculoskeletal fellowship were also recorded.


Noncontrast MRI identified SLAP lesions in fifty-four of 144 shoulders, yielding an overall sensitivity of 38% (95% confidence interval [CI] = 30%, 46%). Specificity was 94% (95% CI = 87%, 98%), with six SLAP lesions diagnosed in 100 shoulders that did not contain the lesion. Musculoskeletal fellowship-trained radiologists performed with higher sensitivity than those who had not completed the fellowship (46% versus 19%; p = 0.009).


Our results demonstrate a low sensitivity and high specificity in the diagnosis of Type-II SLAP lesions with noncontrast MRI in this community setting. Musculoskeletal fellowship-trained radiologists had significantly higher sensitivities in accurately diagnosing the lesion than did radiologists without such training. Noncontrast MRI is not a reliable diagnostic tool for Type-II SLAP lesions in a community setting.

Level of Evidence: 

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    William D. Murrell, MD
    Posted on February 22, 2013
    Not sure that MR arthrogram is better than uncontrasted MR
    Dubai Bone and Joint Center

    First of all, congratulations on a very well presented discussion on a very provocative subject. Two years ago, I would have agreed fully with your study hypotheses, without question. However, our center has embarked upon a retrospective analysis on 100 consecutive shoulder arthroscopic surgeries performed by a single surgeon to correlate preoperative history, physical exam, functional testing, and imaging with findings at the time of surgery. Similarly as reported in your study, 75% of the MRIs were ordered by community GPs and non orthopaedic specialists on various quality devices, and 25% of the studies were MRI arthrograms completed either at our center or one other center both with MSK radiologists. In the analysis of labral pathology, we were surprised that the uncontrasted MR outperformed MR arthrogram in sensitivity, specificity, and accuracy. Another interesting finding was that accuracy of the physical exam tests for labral pathology had sensitivities in the poor to fair range; basically stated, none of the tests were predictive of significant (surgically treated) shoulder lesions. Our study, has many weaknesses, however my insistence on obtaining MR arthrograms, as I did when I practiced in the US, has waned. I am not sure, at this time, that the extra effort is worth it. Patients selected for surgery with a long standing history of symptoms and failure of nonoperative treatment, with uncontrasted MR, resulted in patients resulted in very good 1-2 year outcomes. Again not sure the cost of the MR arthrogram gives any overwhelming benefit to the diagnosis or treatment in this group of patients.

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