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Published online before print November 21, 2002, 10.1148/radiol.2261012090
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(Radiology 2003;226:165-170.)
© RSNA, 2002

Musculoskeletal Imaging

Articular Cartilage Lesions of the Glenohumeral Joint: Diagnostic Effectiveness of MR Arthrography and Prevalence in Patients with Subacromial Impingement Syndrome1

Daniel V. Guntern, MD, Christian W. A. Pfirrmann, MD, Marius R. Schmid, MD, Marco Zanetti, MD, Christoph A. Binkert, MD, Alberto G. Schneeberger, MD and Juerg Hodler, MD

1 From the Departments of Radiology (D.V.G., C.W.A.P., M.R.S., M.Z., C.A.B., J.H.) and Orthopedic Surgery (A.G.S.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. From the 2001 RSNA scientific assembly. Received December 26, 2001; revision requested February 27, 2002; revision received March 29; accepted May 13. Address correspondence to C.W.A.P. (e-mail: christian@pfirrmann.ch).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
PURPOSE: To determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of magnetic resonance (MR) arthrography in detecting such cartilage abnormalities.

MATERIALS AND METHODS: MR arthrographic images obtained in 52 consecutive patients (mean age, 45.8 years; age range, 17-73 years; 26 male and 26 female patients) were retrospectively evaluated for glenohumeral cartilage lesions. Two experienced musculoskeletal radiologists who were blinded to the arthroscopy report independently analyzed the articular cartilage. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Arthroscopic findings were the standard of reference. Sensitivity, specificity, accuracy, and interobserver agreement were calculated.

RESULTS: At arthroscopy, humeral cartilage lesions were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid were less frequent (eight patients; frequency, 15%): Three were subtle, and five were marked. For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (humeral lesions, {kappa} = 0.20; glenoidal lesions, {kappa} = 0.27).

CONCLUSION: Glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The performance of MR arthrography in the detection of glenohumeral cartilage lesions is moderate.

© RSNA, 2002

Index terms: Cartilage, MR, 414.121411 • Shoulder, arthritis, 414.779 • Shoulder, arthrography, 414.121411 • Shoulder, MR, 414.121411


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Magnetic resonance (MR) arthrography is widely accepted in the assessment of the glenohumeral joint. The diagnostic performance and criteria for the evaluation of many of the articular structures of the glenohumeral joint, such as the rotator cuff, the glenoid labrum, and the biceps tendon, are well known (1-5). However, cartilage lesions of the glenohumeral joint are not routinely diagnosed at MR imaging or MR arthrography, despite their large extent and clinical importance. The integrity of the cartilage surface of the glenohumeral joint has an influence on the differential diagnosis of shoulder pain and, many times, on the treatment plan (6). Arthroscopic findings are considered the standard of reference for the assessment of the glenohumeral cartilage.

The femorotibial and femoropatellar cartilage, which are relatively thick (approximately 4 mm for femorotibial cartilage) (7), have been investigated extensively by using MR imaging (8-16). In a few studies, investigators have evaluated thinner articular cartilages, such as those present in the hip (17,18), ankle (19), and other small joints (20,21). Conventional MR imaging findings of glenohumeral cartilage have rarely been published (22-25). To our knowledge, the performance of MR arthrography in the assessment of the articular cartilage of the glenohumeral joint has not yet been evaluated.

Early degenerative changes of the glenohumeral joint have been shown to be clinically important, since they can simulate symptoms of shoulder impingement syndrome (6).

The purpose of our study was to determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of MR arthrography in detecting such cartilage abnormalities.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Patients
Fifty-two consecutive patients were studied retrospectively during a 1-year period. Inclusion criteria were (a) clinical diagnosis of subacromial shoulder impingement syndrome, (b) MR arthrography of the shoulder performed at our institution according to a standardized protocol, (c) arthroscopy performed at our institution, and (d) arthroscopy report with a precise description of the glenohumeral cartilage. During the same time period, 284 patients from our outpatient shoulder clinic underwent MR arthrography at our institution and 251 patients underwent arthroscopy of the shoulder. Sixty-two patients underwent arthroscopy to evaluate subacromial impingement. Fifty-two patients met all inclusion criteria. The institutional review board does not require its approval or informed consent for the review of patient records or images. Patient rights are protected by a law that requires patients to be informed about the possibility that their charts and radiographs will be reviewed for scientific purposes.

Twenty-six patients were male, and 26 were female. Age ranged between 17 and 73 years (mean age, 45.8 years). Thirty right and 22 left shoulders were evaluated. At arthroscopy, 32 patients received a diagnosis of subacromial impingement syndrome (supraspinatus tendinopathy or partial tear, narrowing of the subacromial space due to a subacromial spur, osteoarthritis of the acromioclavicular joint, or subacromial bursitis), 23 had a full-thickness rotator cuff tear, and 16 had a superior labrum anteroposterior, or SLAP, lesion (more than one diagnosis possible).

MR Imaging
MR imaging was performed with a 1.0-T scanner (Expert; Siemens Medical Systems, Erlangen, Germany). The shoulder was placed in a dedicated Helmholtz configuration receive-only shoulder coil with the arm in a neutral position and the thumb pointing upward. All patients underwent MR arthrography after injection of 12 mL of gadoteridol (ProHance; Bracco Diagnostics, Princeton, NJ) solution with a concentration of 2 mmol/L. Informed patient consent was obtained before MR arthrography. T1-weighted spin-echo images were obtained in the coronal plane with fat saturation (800/20 [repetition time msec/echo time msec], 4-mm section thickness, 160 x 160-mm field of view, 192 x 256 matrix), in the transverse plane (580/20, 4-mm section thickness, 140 x 140-mm field of view, 512 x 224 matrix), and in the sagittal plane (700/12, 5-mm section thickness, 160 x 160-mm field of view, 256 x 192 matrix). T2-weighted fast spin-echo images (3,500/98, 4-mm section thickness, 160 x 160-mm field of view, 512 x 230 matrix) and intermediate-weighted fast spin-echo images (3,500/16, 4-mm section thickness, 160 x 160-mm field of view, 512 x 230 matrix) were both obtained in the coronal plane.

Image Analysis
Two experienced musculoskeletal radiologists (M.R.S., M.Z.) independently analyzed the articular cartilage. They were blinded to the arthroscopy report. The readers analyzed all images at once. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Imaging criteria for subtle cartilage lesions included signal intensity alterations or irregular surface of the cartilage and superficial cartilage defects. Marked lesions were cartilage defects with more than 50% of the cartilage thickness and defects reaching the subchondral bone. Arthroscopic findings were the standard of reference. At arthroscopy, irregular surface of the cartilage, cartilage fraying or softening, and superficial cartilage defects were considered subtle lesions. Cartilage lesions of more than 50% of the cartilage thickness and defects reaching the subchondral bone were considered marked.

Statistical Analysis
The frequency of cartilage lesions at arthroscopy was calculated. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of MR arthrography in detecting articular cartilage lesions were assessed for all lesions and for marked cartilage lesions. {kappa} statistics were used to calculate interobserver agreement (26): A {kappa} value of less than 0.20 indicated poor agreement; 0.21-0.40, fair agreement; 0.41-0.60, moderate agreement; 0.61-0.80, good agreement; and 0.81-1.00, very good agreement.

Error Analysis
A panel of four musculoskeletal radiologists (including both blinded readers) (M.R.S., M.Z., C.W.A.P., J.H.) and an orthopedic surgeon (A.G.S.) reviewed all cases in which the assessment of the cartilage was wrong. The panel assessed the most probable source of error for each case in consensus, together with the arthroscopy report. Possible sources of misdiagnosis were insufficient technique (inhomogeneous intraarticular contrast, poor intraarticular contrast, motion artifacts, and chemical shift artifact), the specific anatomy of the glenohumeral joint (thin humeral cartilage), or reading errors.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
At arthroscopy, humeral cartilage lesions (Figs 1, 2) were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid (Fig 3) were found in eight patients (frequency, 15%). Three lesions were graded as subtle and five as marked.



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  		Figure 1a. (a) Transverse T1-weighted spin-echo 580/20 and (b) coronal T1-weighted fat-saturated spin-echo 800/20 MR arthrographic images of a shoulder with an arthroscopically proven marked humeral cartilage lesion (arrowheads).

 


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  		Figure 1b. (a) Transverse T1-weighted spin-echo 580/20 and (b) coronal T1-weighted fat-saturated spin-echo 800/20 MR arthrographic images of a shoulder with an arthroscopically proven marked humeral cartilage lesion (arrowheads).

 


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  		Figure 2a. Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with an arthroscopically proven subtle humeral cartilage lesion represented by an irregular surface (arrowheads) of the articular cartilage.

 


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  		Figure 3b. Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with an arthroscopically proven marked cartilage lesion (arrowheads) at the glenoid.

 
Table 1 summarizes the results for the assessment of cartilage lesions at MR arthrography for all lesions and for marked lesions. For the humeral cartilage, the diagnosis was correct in 40 of 52 cases for reader 1; five cases were false-positive, and seven were false-negative. For reader 2, 34 of 52 cases were diagnosed correctly; 18 were false-positive, and none were false-negative. Regarding the cartilage of the glenoid cavity, both readers had 32 correct diagnoses. Reader 1 had 15 false-positive and two false-negative diagnoses, and reader 2 had 16 false-positive and two false-negative diagnoses.


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  		TABLE 1. Diagnostic Effectiveness of MR Arthrography for Glenohumeral Cartilage Lesions

 
For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (Table 2; humeral cartilage, {kappa} = 0.20; glenoidal cartilage, {kappa} = 0.27).


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  		TABLE 2. Interobserver Agreement for the Diagnosis and Grading of Articular Cartilage Lesions of the Glenohumeral Joint

 
The results of the error analysis are summarized in Table 3. False-positive results were more common than were false-negative ones. An important source of error on the glenoidal side was the cartilage-labrum transition zone, which gave the impression of a cartilage defect (Fig 4a). This led to 10 false-positive results for reader 1 and 13 false-positive results for reader 2. On the humeral side, the thin articular cartilage (Fig 4b) was a major source of error and was responsible for all false-positive results for reader 1 and for eight false-positive results for reader 2. Signal alteration in the articular cartilage was the reason for two false-positive results both for reader 1 in the glenoidal cartilage and for reader 2 for the humeral cartilage. Reader 1 diagnosed three false-positive lesions in the humeral cartilage, which could only be seen in the sagittal plane. Technical reasons, such as inhomogeneous intraarticular contrast, motion artifacts, and chemical-shift artifacts, were rare causes of errors.


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  		TABLE 3. Error Analysis of False-Positive and False-Negative Results

 


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  		Figure 4a. (a) Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with arthroscopically normal glenoidal cartilage. The cartilage-labrum transition zone (arrowheads) was misinterpreted as a cartilage defect. (b) Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with arthroscopically proven normal humeral cartilage. The humeral cartilage (arrowheads) is thin, leading to the false impression of osteoarthritis with generalized thinning of the cartilage.

 


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  		Figure 4b. (a) Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with arthroscopically normal glenoidal cartilage. The cartilage-labrum transition zone (arrowheads) was misinterpreted as a cartilage defect. (b) Transverse T1-weighted spin-echo 580/20 MR arthrographic image of a shoulder with arthroscopically proven normal humeral cartilage. The humeral cartilage (arrowheads) is thin, leading to the false impression of osteoarthritis with generalized thinning of the cartilage.

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
REFERENCES
 
Primary osteoarthritis of the glenohumeral joint is considered rare compared with that in other joints, such as the knee or hip. Glenohumeral osteoarthritis is usually secondary to trauma or to other disorders, such as calcium pyrophosphate dihydrate or hydroxyapatite crystal deposition disease, hemophilia, acromegaly, epiphyseal dysplasia, and alkaptonuria (27). An association between osteoarthritis of the glenohumeral joint and lesions of the rotator cuff and subacromial impingement syndrome has also been emphasized (6). At autopsy, Petersson (28) found evidence of rotator cuff disease in 75% of shoulders with cartilage lesions. At arthrography, rotator cuff lesions were found in more than 90% of shoulders with glenohumeral osteoarthritis (29).

Subacromial impingement syndrome occurs frequently. Impingement results from entrapment of the supraspinatus tendon between the humeral head and the anterior part of the acromion, coracoacromial ligament, or acromioclavicular joint (30). MR imaging findings of subacromial impingement syndrome are well known (31). Subacromial impingement syndrome is associated with subacromial bursitis, tendinosis of the supraspinatus tendon, and partial or complete supraspinatus tendon rupture. Other findings include subacromial or acromioclavicular joint spurs, hypertrophic acromioclavicular joint capsule, and narrow subacromial space (31). However, clinical symptoms of subacromial impingement syndrome may be simulated by early degenerative changes of the glenohumeral cartilage (6). In our patients with subacromial impingement, these lesions were found in 29% on the humeral side and in 19% on the glenoidal side.

Reliable assessment of the cartilage of the shoulder by means of conventional MR arthrography is important for the differential diagnosis of shoulder pain, since glenohumeral cartilage damage may simulate impingement syndrome, and treatment options for these two conditions are different (6). After exclusion of other shoulder abnormalities, treatment of glenohumeral osteoarthritis is primarily nonsurgical, such as nonsteroidal antiinflammatory medication and physical therapy. If this fails, arthroscopic debridement of the cartilage lesions is a treatment option that has shown good to excellent results in 80% of patients with glenohumeral osteoarthritis (32).

Contrary to MR imaging of glenohumeral cartilage, MR imaging of knee cartilage has been investigated extensively. Sensitivity, specificity, and accuracy ranged between 60%-70% and 100% (8-16). Glenohumeral cartilage has rarely been assessed by means of MR imaging. In two studies (22,23), investigators measured the thickness of the glenohumeral cartilage on MR images and compared it with that of the corresponding cadaveric specimen. In two other studies (24,25), investigators described several cases of traumatic chondral or osteochondral cartilage lesions. To our knowledge, no studies directly comparable to our investigation with assessment of sensitivity, specificity, and accuracy of MR imaging in detecting glenohumeral cartilage lesions have been published at the present time.

When compared with results in studies of cartilage lesions of the knee, the diagnostic effectiveness of MR arthrography in detecting glenohumeral cartilage lesions in our study was lower. This could have several reasons. In contrast to the articular cartilage in the knee, which measures up to 4 mm thick (7), glenohumeral cartilage is much thinner (mean thickness at the humeral head, 1.24 mm; mean thickness at the glenoid fossa, 1.88 mm) (23). This could lead to difficulties in assessing signal alterations and surface irregularities.

The results of the error analysis performed at the end of our investigation demonstrated that a substantial portion of the false-positive results, especially on the humeral side, were due to thin cartilage at MR arthrography, which was difficult to assess. When chemical shift is taken into consideration, humeral cartilage may be represented by only 1 or 2 pixels, which renders assessment of partial thickness damage difficult. In an anatomic cadaveric MR study (22), the thickness of the glenohumeral cartilage on MR images was measured and compared with that of the corresponding anatomic specimens. A tendency to overestimate the thickness of thin cartilage and underestimate that of thick cartilage was noted.

Another possible reason for the lower performance is our MR protocol, which was specifically tailored to evaluate structures such as the rotator cuff, the glenoid labrum, and the biceps tendon. Our protocol included spin-echo and fast spin-echo sequences only. On the basis of experiences with MR imaging of cartilage of the knee (14,15), fat-suppressed three-dimensional spoiled gradient-echo MR imaging has a higher sensitivity in depicting cartilage defects than does conventional MR imaging (10,13,15,22). It is possible that with special cartilage sequences, articular cartilage and its abnormalities would be more discernible, and thus, diagnostic effectiveness would be higher.

The number of cartilage lesions was generally overestimated in our study. False-positive results were far more common than were false-negative results. On the glenoidal side, many false-positive cartilage lesions were diagnosed at the caudal cartilage–labrum transition zone. The inner edge of the glenoid labrum and the thinner peripheral cartilage of the glenoid lead presumably to volume averaging, simulating a cartilage defect (Fig 4a). The cartilage-labrum transition zone should be analyzed carefully, since it represents a potential diagnostic pitfall.

In conclusion, glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The effectiveness of MR arthrography with conventional sequences is moderate in the detection of glenohumeral cartilage lesions.


   FOOTNOTES
 
Author contributions: Guarantors of integrity of entire study, D.V.G., C.W.A.P., J.H.; study concepts, J.H., M.Z.; study design, M.Z., C.W.A.P.; literature research, D.V.G., A.G.S.; clinical studies, C.A.B., A.G.S.; data acquisition, M.R.S., M.Z.; data analysis/ interpretation, C.W.A.P.; statistical analysis, C.W.A.P.; manuscript preparation, D.V.G., C.W.A.P.; manuscript definition of intellectual content, D.V.G., C.W.A.P., J.H.; manuscript editing, D.V.G., C.W.A.P.; manuscript revision/review, M.Z., J.H.; manuscript final version approval, J.H.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 

  1. Hodler J, Kursunoglu-Brahme S, Snyder SJ, et al. Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. Radiology 1992; 182:431-436.[Abstract/Free Full Text]
  2. Zanetti M, Weishaupt D, Gerber C, Hodler J. Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol 1998; 170:1557-1561.[Abstract/Free Full Text]
  3. Bencardino JT, Beltran J, Rosenberg ZS, et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214:267-271.[Abstract/Free Full Text]
  4. Jee WH, McCauley TR, Katz LD, Matheny JM, Ruwe PA, Daigneault JP. Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis. Radiology 2001; 218:127-132.[Abstract/Free Full Text]
  5. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 1999; 213:709- 714.[Abstract/Free Full Text]
  6. Ellman H, Harris E, Kay SP. Early degenerative joint disease simulating impingement syndrome: arthroscopic findings. Arthroscopy 1992; 8:482-487.[Medline]
  7. Hall FM, Wyshak G. Thickness of articular cartilage in the normal knee. J Bone Joint Surg Am 1980; 62:408-413.[Free Full Text]
  8. McCauley TR, Kier R, Lynch KJ, Jokl P. Chondromalacia patellae: diagnosis with MR imaging. AJR Am J Roentgenol 1992; 158:101-105.[Abstract/Free Full Text]
  9. Brown TR, Quinn SF. Evaluation of chondromalacia of the patellofemoral compartment with axial magnetic resonance imaging. Skeletal Radiol 1993; 22:325-328.[Medline]
  10. Recht MP, Kramer J, Marcelis S, et al. Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology 1993; 187:473-478.[Abstract/Free Full Text]
  11. Rose PM, Demlow TA, Szumowski J, Quinn SF. Chondromalacia patellae: fat-suppressed MR imaging. Radiology 1994; 193:437-440.[Abstract/Free Full Text]
  12. Gagliardi JA, Chung EM, Chandnani VP, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 1994; 163:629-636.[Abstract/Free Full Text]
  13. Disler DG, McCauley TR, Wirth CR, Fuchs MD. Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy. AJR Am J Roentgenol 1995; 165:377-382.[Abstract/Free Full Text]
  14. Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology 1996; 198:209-212.[Abstract/Free Full Text]
  15. Disler DG, McCauley TR, Kelman CG, et al. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol 1996; 167:127-132.[Abstract/Free Full Text]
  16. Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 1998; 80:1276-1284.
  17. Hodler J, Trudell D, Pathria MN, Resnick D. Width of the articular cartilage of the hip: quantification by using fat-suppression spin-echo MR imaging in cadavers. AJR Am J Roentgenol 1992; 159:351-355.[Abstract/Free Full Text]
  18. Konig H, Sauter R, Deimling M, Vogt M. Cartilage disorders: comparison of spin-echo, CHESS, and FLASH sequence MR images. Radiology 1987; 164:753-758.[Abstract/Free Full Text]
  19. Tan TC, Wilcox DM, Frank L, et al. MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers. Skeletal Radiol 1996; 25:749-755.[CrossRef][Medline]
  20. Uhl M, Krauss M, Kern S, et al. The knee joint in early juvenile idiopathic arthritis. An ROC study for evaluating the diagnostic accuracy of contrast-enhanced MR imaging. Acta Radiol 2001; 42:6-9.
  21. Peterfy CG, van Dijke CF, Lu Y, et al. Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging. AJR Am J Roentgenol 1995; 165:371-375.[Abstract/Free Full Text]
  22. Hodler J, Loredo RA, Longo C, Trudell D, Yu JS, Resnick D. Assessment of articular cartilage thickness of the humeral head: MR-anatomic correlation in cadavers. AJR Am J Roentgenol 1995; 165:615-620.[Abstract/Free Full Text]
  23. Yeh LR, Kwak S, Kim YS, et al. Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers. Skeletal Radiol 1998; 27:500-504.[CrossRef][Medline]
  24. Yu JS, Greenway G, Resnick D. Osteochondral defect of the glenoid fossa: cross-sectional imaging features. Radiology 1998; 206:35-40.[Abstract/Free Full Text]
  25. Carroll KW, Helms CA, Speer KP. Focal articular cartilage lesions of the superior humeral head: MR imaging findings in seven patients. AJR Am J Roentgenol 2001; 176:393-397.[Abstract/Free Full Text]
  26. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33:363-374.[CrossRef][Medline]
  27. Resnick D. Degenerative diseases: shoulder In: Diagnosis of bone and joint disorders. Vol 3. Philadelphia, Pa: Saunders, 1995; 1302-1312.
  28. Petersson CJ. Degeneration of the gleno-humeral joint: an anatomical study. Acta Orthop Scand 1983; 54:277-283.[Medline]
  29. Kernwein GA. Roentgenographic diagnosis of shoulder dysfunction. JAMA 1965; 194:1081-1085.
  30. Neer CSd. Impingement lesions. Clin Orthop 1983; 70–77.
  31. Seeger LL, Gold RH, Bassett LW, Ellman H. Shoulder impingement syndrome: MR findings in 53 shoulders. AJR Am J Roentgenol 1988; 150:343-347.[Abstract/Free Full Text]
  32. Weinstein DM, Bucchieri JS, Pollock RG, Flatow EL, Bigliani LU. Arthroscopic debridement of the shoulder for osteoarthritis. Arthroscopy 2000; 16:471-476.[Medline]



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RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE