Diagnostic performance of shoulder magnetic resonance arthrography for labral tears having surgery as reference: comparison of high-resolution isotropic 3D sequence (THRIVE) with standard protocol

Purpose: To compare the diagnostic performance of T1 high-resolution isotropic volume excitation (THRIVE) sequence with that of a standard protocol for direct shoulder magnetic resonance arthrography (MRA) for the diagnosis of superior labral anterior-to-posterior (SLAP) and Bankart lesions, using arthroscopy findings as a reference standard. Materials and methods: We retrospectively studied 84 patients who underwent direct shoulder 3T MRA using THRIVE and two-dimensional three-plane proton-density fat-suppressed (2D-PD-FS) sequences. One reviewer evaluated the contrast-to-noise ratio (CNR) as a quantitative image quality. Other two reviewers independently evaluated the subjective image noise, image sharpness, and radiologic diagnosis as qualitative image quality. Arthroscopic surgical findings were considered the reference standard. Wilcoxon rank sum, Chi-square/Fisher’s exact, and DeLong’s tests, as well as intraclass correlation coefficients (ICCs) were used to evaluate differences between THRIVE and 2D-PD-FS images. Results: THRIVE images had significantly higher CNR (p < 0.001), and subjective ratings of image noise (p = 0.009) and sharpness (p = 0.039) than 2D-PD-FS images (p < 0.001). THRIVE images had similar (p ≥ 0.18) diagnostic performance (sensitivity, 93.0–97.2%; specificity, 95.8–100%; accuracy, 95.2–97.6%) for the diagnosis of SLAP and Bankart lesions with excellent agreement (ICC = 0.898–0.942) when compared to 2D-PD-FS images (sensitivity, 86.1–91.7%; specificity, 93.8–95.8%; accuracy, 90.5–92.9%; agreement, ICC = 0.782–0.858). The scan time was reduced by 69% for THRIVE sequence compared to 2D-PD-FS sequence (2 min 40 s vs. 8 min 40 s). Conclusion: The THRIVE sequence may be helpful in the diagnosis of SLAP and Bankart lesions, and may be routinely used during direct shoulder 3T MRA.