Glenoid Bone Loss in Shoulder Instability: Superiority of Three-Dimensional Computed Tomography over Two-Dimensional Magnetic Resonance Imaging Using Established Methodology

Abstract

Backgroud: Recent literature suggests that three-dimensional magnetic resonance imaging (3D MRI) can replace 3D computed tomography (3D CT) when evaluating glenoid bone loss in patients with shoulder instability. We aimed to examine if 2D MRI in conjunction with a validated predictive formula for assessment of glenoid height is equivalent to the gold standard 3D CT scans for patients with recurrent glenohumeral instability.

Methods: Patients with recurrent shoulder instability and available imaging were retrospectively reviewed. Glenoid height on 3D CT and 2D MRI was measured by two blinded raters. Difference and equivalence testing were performed using a paired t-test and two one-sided tests, respectively. The interclass correlation coefficient (ICC) was used to test for interrater reliability, and percent agreement between the measurements of one reviewer was used to assess intrarater reliability.

Results: Using an equivalence margin of 1 mm, 3D CT and 2D MRI were found to be different (p = 0.123). The mean glenoid height was significantly different when measured on 2D MRI (39.09 ± 2.93 mm) compared to 3D CT (38.71 ± 2.89 mm) (p = 0.032). The mean glenoid width was significantly different between 3D CT (30.13 ± 2.43 mm) and 2D MRI (27.45 ± 1.72 mm) (p < 0.001). The 3D CT measurements had better interrater agreement (ICC, 0.91) than 2D MRI measurements (ICC, 0.8). intrarater agreement was also higher on CT.

Conclusions: Measurements of glenoid height using 3D CT and 2D MRI with subsequent calculation of the glenoid width using a validated methodology were not equivalent, and 3D CT was superior. Based on the validated methods for the measurement of glenoid bone loss on advanced imaging studies, 3D CT study must be preferred over 2D MRI in order to estimate the amount of glenoid bone loss in candidates for shoulder stabilization surgery and to assist in surgical decision-making.

Keywords: Computed tomography dislocation; Glenohumeral; Images; Magnetic resonance imaging; Three dimensional imaging.

Fig. 1. Glenoid height measurement using three-dimensional reconstruction of glenoid fossa. After subtracting the humeral head, the glenoid fossa was rotated to an en face view. The glenoid fossa height was then measured and recorded along its longest axis from the superior articular surface to the inferior articular surface, in parallel to the scapular spine.

Fig. 2. (A) Sagittal T1-weighted magnetic resonance imaging (MRI) with glenoid height. The ruler head was measured from the superior to inferior articular surfaces of the glenoid on the coronal image for confirmation. (B) Coronal T1-weighted MRI with superior glenoid labelled. The superior glenoid is indicated by the white arrow. Using the crosshatch localization feature, confirmation of the glenoid height was attained on the sagittal image. (C) Coronal T1-weighted MRI with inferior glenoid labelled. The inferior glenoid is indicated by the white arrow. Using the crosshatch localization feature, confirmation of the glenoid height was attained on the sagittal image.

Fig. 3. (A) Interclass correlation coefficient (ICC) for computed tomography (CT) measurement of the glenoid height (ICC, 0.91). (B) ICC for magnetic resonance imaging (MRI) measurement of the glenoid height (ICC, 0.8).