"Dynamic ABER" sequence using gradient recalled echo radial k-space sampling for kinematic evaluation of humeral excursion related to the glenoid: a feasibility study in 15 patients with a 3-year follow-up.

Abstract

BackgroundRapid real-time magnetic resonance (MR) sequences enable dynamic articular kinematic assessment. The abduction-external rotation (ABER) position has long been used to characterize glenohumeral pathology.PurposeTo evaluate a dynamic gradient recall echo (GRE) sequence for ABER-positioned glenohumeral joint kinematic assessment correlating with subjective instability and clinical apprehension testing.Material and MethodsSymptomatic patients were scanned using a routine MR arthrogram protocol supplemented by an additional "dynamic ABER" GRE technique acquired with the arm abducted and then internally-externally rotated in real time. Dynamic motion of the humeral head between the extremes of motion in the abducted and externally rotated positions was evaluated. The cohort was followed for 3 years.ResultsA total of 15 dynamic ABER studies in 15 different patients were evaluated by three readers (right: n=9; left: n=6), with a mean age of 30 years (range=19-45 years). Good accuracy of the humeral head excursion between the abducted and externally-internally rotated positions (AUC=0.88) was observed as a test for positively detecting instability. An association was detected between clinical instability and mean humeral head excursion as measured by all three readers (P = 0.026), although no association between positive apprehension testing and mean humeral head excursion was detected. There was a trend towards surgery-naïve patients with higher mean humeral head excursion subsequently undergoing surgical management (P=0.088), although this did not reach statistical significance.ConclusionCorrelation between subjective instability and humeral head translation demonstrated on a dynamic ABER sequence added to MR shoulder arthrograms was observed but without association with clinical apprehension testing.