La radiologia medica

, Volume 123, Issue 8, pp 620–630 | Cite as

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

  • Sun Hwa Lee
  • Seong Jong YunEmail author
  • Youngno Yoon



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.


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).


The THRIVE sequence may be helpful in the diagnosis of SLAP and Bankart lesions, and may be routinely used during direct shoulder 3T MRA.


T1 high-resolution isotropic volume excitation Direct shoulder MR arthrography SLAP lesion Bankart lesion Comparative study 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, as this was a retrospective study we state that for this type of study formal consent is not required.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Sebro R, Oliveira A, Palmer WE (2014) MR arthrography of the shoulder: technical update and clinical applications. Semin Musculoskelet Radiol 18:352–364CrossRefPubMedGoogle Scholar
  2. 2.
    Sconfienza LM, Albano D, Messina C, Silvestri E, Tagliafico AS (2018) How, when, why in magnetic resonance arthrography: an international survey by the European Society of Musculoskeletal Radiology (ESSR). Eur Radiol. [Epub ahead of print] CrossRefPubMedGoogle Scholar
  3. 3.
    Ng AW, Hung EH, Griffith JF, Tong CS (2013) Cho CC (2013) comparison of ultrasound versus fluoroscopic guided rotator cuff interval approach for MR arthrography. Clin Imaging 37:548–5534CrossRefPubMedGoogle Scholar
  4. 4.
    Lee YH, Choi YR, Kim S, Song HT, Suh JS (2013) Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging 31:221–226CrossRefPubMedGoogle Scholar
  5. 5.
    Hussain SM (2008) UNMC advances 3.0T abdominal imaging. Field Strength Issue 35:8–13Google Scholar
  6. 6.
    Wieslander SB, Rappeport ED, Lausten GS, Thomsen HS (1998) Multiplanar reconstruction in MR imaging of the knee. Comparison with standard sagittal and coronal images. Acta Radiol 39:116–119PubMedGoogle Scholar
  7. 7.
    Kijowski R, Davis KW, Woods MA et al (2009) Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging—diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 252:486–495CrossRefPubMedGoogle Scholar
  8. 8.
    Jung JY, Jee WH, Park MY, Lee SY, Kim JM (2012) Meniscal tear configurations: categorization with 3D isotropic turbo spin-echo MRI compared with conventional MRI at 3 T. Am J Roentgenol 198:W173–W180CrossRefGoogle Scholar
  9. 9.
    Wagner SC, Schweitzer ME, Weishaupt D (2001) Temporal behavior of intraarticular gadolinium. J Comput Assist Tomogr 25:661–670CrossRefPubMedGoogle Scholar
  10. 10.
    Kopka L, Funke M, Fischer U, Keating D, Oestmann J, Grabbe E (1994) MR arthrography of the shoulder with gadopentetate dimeglumine: influence of concentration, iodinated contrast material, and time on signal intensity. Am J Roentgenol 163:621–623CrossRefGoogle Scholar
  11. 11.
    Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279CrossRefPubMedGoogle Scholar
  12. 12.
    Woertler K, Waldt S (2006) MR imaging in sports-related glenohumeral instability. Eur Radiol 16:2622–2636CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMedGoogle Scholar
  14. 14.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kim MS, Park CS, Lee EJ et al (2010) Magnetic resonance colonography: comparison between T1 high resolution isotropic volume excitation (THRIVE) and balanced fast field echo (bFFE) using an air enema or water gadolinium enema. Clin Radiol 65:319–324CrossRefPubMedGoogle Scholar
  16. 16.
    Foti G, Avanzi P, Mantovani W et al (2017) MR arthrography of the shoulder: evaluation of isotropic 3D intermediate-weighted FSE and hybrid GRE T1-weighted sequences. Radiol Med 122:353–360CrossRefPubMedGoogle Scholar
  17. 17.
    Jung JY, Jee WH, Park MY, Lee SY, Kim YS (2013) SLAP tears: diagnosis using 3-T shoulder MR arthrography with the 3D isotropic turbo spin-echo space sequence versus conventional 2D sequences. Eur Radiol 23:487–495CrossRefPubMedGoogle Scholar
  18. 18.
    Jung JY, Yoon YC, Choi SH, Kwon JW, Yoo J, Choe BK (2009) Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology 250:498–505CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JH, Yoon YC, Jee S, Kwon JW, Cha JG, Yoo JC (2014) Comparison of three-dimensional isotropic and two-dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears. Korean J Radiol 15:771–780CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lee YH, Kim AH, Suh JS (2014) Magnetic resonance visualization of surgical classification of rotator cuff tear: comparison with three-dimensional shoulder magnetic resonance arthrography at 3.0 T. Clin Imaging 38:858–863CrossRefPubMedGoogle Scholar
  21. 21.
    Oh DK, Yoon YC, Kwon JW et al (2009) Comparison of indirect isotropic MR arthrography and conventional MR arthrography of labral lesions and rotator cuff tears: a prospective study. Am J Roentgenol 192:473–479CrossRefGoogle Scholar
  22. 22.
    Park HJ, Lee SY, Rho MH, Kwon HJ, Kim MS, Chung EC (2015) The usefulness of the three-dimensional enhanced T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology: comparison with two-dimensional enhanced T1 fat saturation MR. Br J Radiol 88:20140830CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Park SY, Lee IS, Park SK, Cheon SJ, Ahn JM, Song JW (2014) Comparison of three-dimensional isotropic and conventional MR arthrography with respect to the diagnosis of rotator cuff and labral lesions: focus on isotropic fat-suppressed proton density and VIBE sequences. Clin Radiol 69:e173–e182CrossRefPubMedGoogle Scholar
  24. 24.
    Jung JY, Jee WH, Park MY, Lee SY, Kim YS (2012) Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences. Skeletal Radiol 41:1401–1410CrossRefPubMedGoogle Scholar
  25. 25.
    Park HJ, Lee SY, Kim MS et al (2015) Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR. Br J Radiol 88:20140147CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Dietrich TJ, Zanetti M, Saupe N, Pfirrmann CW, Fucentese SF, Hodler J (2010) Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography. Skeletal Radiol 39:473–480CrossRefPubMedGoogle Scholar
  27. 27.
    Magee T (2007) Can isotropic fast gradient echo imaging be substituted for conventional T1 weighted sequences in shoulder MR arthrography at 3 Tesla? J Magn Reson Imaging 26:118–122CrossRefPubMedGoogle Scholar
  28. 28.
    Lee MJ, Motamedi K, Chow K, Seeger LL (2008) Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum. Skeletal Radiol 37:19–25CrossRefPubMedGoogle Scholar
  29. 29.
    Gottsegen CJ, Merkle AN, Bencardino JT, Gyftopoulos S (2017) Advanced MRI techniques of the shoulder joint: current applications in clinical practice. Am J Roentgenol 209:544–551CrossRefGoogle Scholar
  30. 30.
    Rastogi AK, Davis KW, Ross A, Rosas HG (2016) Fundamentals of joint injection. Am J Roentgenol 207:484–494CrossRefGoogle Scholar
  31. 31.
    Fox MG, Petrey WB, Alford B, Huynh BH, Patrie JT, Anderson MW (2012) Shoulder MR arthrography: intraarticular anesthetic reduces periprocedural pain and major motion artifacts but does not decrease imaging time. Radiology 262:576–583CrossRefPubMedGoogle Scholar
  32. 32.
    Lee SH, Lee YH, Song HT, Suh JS (2017) Rapid acquisition of magnetic resonance imaging of the shoulder using three-dimensional fast spin echo sequence with compressed sensing. Magn Reson Imaging 42:152–157CrossRefPubMedGoogle Scholar
  33. 33.
    Lustig M, Donoho D, Pauly JM (2007) Sparse MRI: the application of compressed sensing for rapid MR imaging. Magn Reson Med 58:1182–1195CrossRefPubMedGoogle Scholar
  34. 34.
    Ugas MA, Huynh BH, Fox MG, Patrie JT, Gaskin CM (2014) MR arthrography: impact of steroids, local anesthetics, and iodinated contrast material on gadolinium signal intensity in phantoms at 1.5 and 3.0 T. Radiology 272:475–483CrossRefPubMedGoogle Scholar
  35. 35.
    Messina C, Banfi G, Aliprandi A (2016) Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now. Eur Radiol 26:1221–1225CrossRefPubMedGoogle Scholar
  36. 36.
    Silvestri E, Barile A, Albano D et al (2017) Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology. Radiol Med. PubMedCrossRefGoogle Scholar
  37. 37.
    Messina C, Banfi G, Orlandi D et al (2016) Ultrasound-guided interventional procedures around the shoulder. Br J Radiol 89:20150372CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Sanggye Paik HospitalInje University College of MedicineSeoulRepublic of Korea
  2. 2.Department of RadiologyKyung Hee University Hospital at Gangdong, Kyung Hee University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiology, Gangnam Severance Hospital, College of MedicineYonsei UniversitySeoulRepublic of Korea

Personalised recommendations