Preliminary Diagnosis: Labrum Tear
I. What imaging technique is first-line for this diagnosis
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MR imaging without contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of a labrum tear.
Advantages
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Diagnostic
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It is the imaging modality of choice for evaluating the labral complex and soft tissues around the joint. It’s able to evaluate the presence of secondary complications of labrum tears such as paralabral cysts.
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Noninvasive painless method; does not make use of any ionizing radiation
Disadvantages
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Expensive
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Time-consuming
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Requires marked patient cooperation to limit motion artifact
III. What are the contraindications for the first-line imaging technique?
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Contraindicated in patients with non-MR compatible foreign bodies or metallic hardware
IV. What alternative imaging techniques are available?
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MR arthrography
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CT arthrography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of a labrum tear.
MR arthrography
Advantages
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Superior to conventional MRI in evaluating labrum tears; it’s diagnostic when contrast is seen within the labrum.
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Should be performed in cases clinically suspected of labral tear with negative MR imaging
Disadvantages
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Involves intraarticular injection of contrast material, exposing the patient to all the risks of an invasive procedure and potential discomfort
CT arthrography
Advantages
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High sensitivity and specificity in detecting labral tears
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May be helpful in patients with recurrent symptoms with previous labral surgery.
Disadvantages
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It is an invasive procedure that exposes a patient to all the risks of an invasive procedure and potential discomfort
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Requires a large amount of ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
MR arthrography
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Contraindicated in patients with non-MR compatible foreign bodies or metallic hardware
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Should not be performed where there is suspected infection of the skin or soft tissue close to the needle path
CT arthrography
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CT imaging is contraindicated in a pregnant patient, especially within the first two trimesters.
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CT arthrography should not be performed where there is suspected infection of the skin or soft tissue close to the needle path.
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