ABER Position in Direct MR Arthrography of the Shoulder: Useful Adjunct or Waste of Imaging Time?

 

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Abstract

Purpose The usefulness of direct MR arthrography of the shoulder with additional ABER position (ABER-MRA) has always been discussed. The goals of the following review are to analyze the usefulness of this technique according to the available literature and present recommendations with respect to indications and benefits in diagnostic imaging of shoulder abnormalities in the clinical routine.

Method For this review we assessed the current literature databases of the Cochrane Library, Embase, and PubMed with regard to MRA in the ABER position up to the February 28, 2022. Search terms were “shoulder MRA, ABER”, “MRI ABER”, “MR ABER”, “shoulder, abduction external rotation MRA”, “abduction external rotation MRI” and “ABER position”. The inclusion criteria were prospective and retrospective studies with surgical and/or arthroscopic correlation within 12 months. Overall, 16 studies with 724 patients fulfilled the inclusion criteria: 10 studies dealing with anterior instabilities, three studies with posterior instabilities and seven studies with suspected rotator cuff pathologies (some studies addressing multiple items).

Results For anterior instability the use of ABER-MRA in the ABER position led to a significant increase in sensitivity for detecting lesions of the labral ligamentous complex compared with standard 3-plane shoulder MRA (81 % versus 92 %, p = 0.001) while maintaining high specificity (96 %). ABER-MRA demonstrated high sensitivity and specificity (89 % and 100 %, respectively) for SLAP lesions and was able to detect micro-instability in overhead athletes, but case counts are still very small. With regard to rotator cuff tears, no improvement of sensitivity or specificity could be shown with use of ABER-MRA.

Conclusion Based on the currently available literature, ABER-MRA achieves a level of evidence C in the detection of pathologies of the anteroinferior labroligamentous complex. With regard to the evaluation of SLAP lesions and the exact determination of the degree of rotator cuff injury, ABER-MRA can be of additive value, but is still a case-by-case decision.

Key Points: 

• ABER-MRA is useful in the evaluation of pathologies of the anteroinferior labroligamentous complex

• ABER-MRA does not increase sensitivity or specificity with regard to rotator cuff tears

• ABER-MRA may be helpful for the detection of SLAP lesions and micro-instability in overhead athletes

Citation Format

• Altmann S, Jungmann F, Emrich T et al. ABER Position in Direct MR Arthrography of the Shoulder: Useful Adjunct or Waste of Imaging Time?. Fortschr Röntgenstr 2023; 195: 586 – 595

Publication History

Article published online:
02 March 2023

© 2023. Thieme. All rights reserved.

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• References

• 1 Sconfienza LM, Albana D, Messina C. et al. How, when, why in magnetic resonance arthrography: an international survey by the European Society of Musculoskeletal Radiology (ESSR). Eur Radiol 2018; 28: 2356-2368
  CrossrefPubMedGoogle Scholar
• 2 Smith TO, Drew BT, Toms AP. A meta-analysis of the diagnostic test accuracy of MRA and MRI for detection of glenoid labral injury. Arch Orthop TRauma Surg 2012; 132: 905-919
  CrossrefPubMedGoogle Scholar
• 3 Roy J-S, Braen C, Leblond J. et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterization of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med 2015; 49: 1316-1328
  CrossrefPubMedGoogle Scholar
• 4 Symanski JS, Subhas N, Babb J. et al. Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-analysis. Radiology 2017; 285: 101-113
  CrossrefPubMedGoogle Scholar
• 5 Ajuied A, Mc Garvey CP, Harb Z. et al. Diagnosis of glenoid labral tears using 3 tesla MRI vs. 3-tesla MRA: a systemetic review and meta-analysis. Arch Orthop Trauma Surg 2018; 138: 699-709
  CrossrefPubMedGoogle Scholar
• 6 Saleem AM, Lee JK, Novak LM. Usefuness of the abduction and external rotation views in shoulder MR arthrography. Am J Roentgenol Amer J Roentegenol 2008; 191: 1024-1030
  CrossrefPubMedGoogle Scholar
• 7 Protokollempfehlungen der AG Bildgebende Verfahren des Bewegungsapparates (AG BVB) der Deutschen Röntgengesellschaft (DRG) zu Messsequenzen für die Gelenk-MRT. Fortschr Röntgenstr 2018; 190: 179-195
  PubMedGoogle Scholar
• 8 https://www.dgmsr.de/wp-content/uploads/2019/07/DGMSR-Protokolle-_MSK_Version1_Juli2019.pdf : Empfehlungen der Deutschen Gesellschaft für Muskuloskelettale Radiologie (DGMSR) zur muskuloskelettalen MRT-Diagnostik. Letzter Zugriff 24.11.2022
  PubMed
• 9 Tian C, Meng C, Zheng Z. The Aber position in shoulder MR arthrography for rotator cuff tears. J Pract Radiol 2013; 29: 1627-1631
  PubMedGoogle Scholar
• 10 Qiu W, Tang X, Li Y. et al. Abduction external rotation porition in magentic resonance arthrography for the diagnosis of rotator cuff tears. J Orthop Science 2016; 21: 446-451
  CrossrefPubMedGoogle Scholar
• 11 Quak SM, Brown RR, Trudell D. et al. Glenohumeral joint: comparison of shoulder positions at MR arthrography. Radiology 1998; 208: 375-380
  CrossrefPubMedGoogle Scholar
• 12 Suyama J, Fujita A. [MR arthrographic findings of SLAP lesion type V]. Nihon Hoshasen 2004; 64: 552-556
  PubMedGoogle Scholar
• 13 Song H-T, Huh Y-M, Kim S. et al. Anterior-inferior labral lesions of recurrent shoulder dislocation evaluated by MR arthrography in an adduction internal rotation (ADIR) position. J Magn Reson Imaging 2005; 23: 29-35
  CrossrefPubMedGoogle Scholar
• 14 Chhadia AM, Goldberg BA, Hutchinson MR. Abnormal translation in SLAP lesions on magnetic resonance Imaging abduction externally rotated view. Arthroscopy 2010; 26: 19-25
  CrossrefPubMedGoogle Scholar
• 15 Park MJ, Garcia G, Malhotra A. et al. The evaluation of arthroscopic remplissage by high-resolution by high-resolution magnetic resonance imaging. Am J Sports Med 2012; 40: 2331-2336
  CrossrefPubMedGoogle Scholar
• 16 Zhu M, Young SW, Pinto C. et al. Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial. Shoulder Elbow 2015; 7: 85-93
  CrossrefPubMedGoogle Scholar
• 17 Barile A, Lanni G, Conti L. et al. Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potenstials and limist of MR arthrography compared with arthroscopy. Radiol Med 2013; 118: 112-122
  CrossrefPubMedGoogle Scholar
• 18 Schaeffeler C, Waldt S, Bauer JS. et al. MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol 2014; 24: 1376-1385
  CrossrefPubMedGoogle Scholar
• 19 Tirman PF, Bost FW, Steinbach LS. et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology 1994; 192: 851-856
  CrossrefPubMedGoogle Scholar
• 20 Cvitanic O, Tirman PF, Feller JF. et al. Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. Am J Roentgenol 1997; 169: 837-844
  CrossrefPubMedGoogle Scholar
• 21 Roger B, Skaf A, Hooper AW. et al. Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation. Am J Roentgenol 1999; 172: 1371-1380
  CrossrefPubMedGoogle Scholar
• 22 Wischer TK, Bredella MA, Genant HK. et al. Perthes lesion (a variant of the Bankart lesion): MR imaging and MR arthrographic findings with surgical correlation. Am J Roentgenol Amer J Roentgenol 2002; 178: 233-237
  CrossrefPubMedGoogle Scholar
• 23 Sugimoto H, Suzuki K, Mihara K. et al. MR arthrography of shoulders after suture-anchor Bankart repair. Radiology 2002; 224: 105-111
  CrossrefPubMedGoogle Scholar
• 24 Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology 2002; 224: 470-476
  CrossrefPubMedGoogle Scholar
• 25 Ng AW, Chu CM, Lo WN. et al. Assessment of capsular laxity in patients with recurrent anterior shoulder dislocation using MRI. Am J Roentgenol 2009; 192: 1690-1695
  CrossrefPubMedGoogle Scholar
• 26 Sheah K, Bredella MA, Warner JJ. et al. Transverse thickening along the articular surface of the rotator cuff consistent with the rotator cable: identification with MR arthrography and relevance in rotator cuff evaluation. Am J Roentgenol 2009; 193: 679-686
  CrossrefPubMedGoogle Scholar
• 27 Schreinemachers SA, van der Hulst VP, Jaap Willems W. et al. Is a single direct MR arthrography series in ABER position as accurate in detecting anteroinferior labroligamentous lesions as conventional MR arthography?. Skeletal Radiol 2009; 38: 675-683
  CrossrefPubMedGoogle Scholar
• 28 Schreinemachers SA, van der Hulst VP, Willems WJ. et al. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?. Skeletal Radiol 2009; 38: 967-975
  CrossrefPubMedGoogle Scholar
• 29 Jung JY, Jee WH, Chun HJ. et al. Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: accuracy, and inter- and intra-observer agreements. Acta Radiol 2010; 51: 194-201
  CrossrefPubMedGoogle Scholar
• 30 Borrero CG, Casagranda BU, Towers JD. et al. Magnetic resonance appearance of posterosuperior labral peel back during humeral abduction and external rotation. Skeletal Radiol 2010; 39: 19-26
  CrossrefPubMedGoogle Scholar
• 31 Modi CS, Karthikeyan S, Marks A. et al. Accuracy of abduction-external rotation MRA versus standard MRA in the diagnosis of intra-articular shoulder pathology. Orthopedics 2013; 36: e337-e342
  PubMedGoogle Scholar
• 32 Tian C-Y, Cui G-Q, Zheng Z-Z. et al. The added value of ABER position for the detection and classificationof anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 2013; 82: 651-657
  CrossrefPubMedGoogle Scholar
• 33 Iossifidis A, Ibrahim E, Togias PG. et al. Accuracy of Magnetic Resonance Arthrography in the Detection and Classification of Chronic Anteroinferior Labrum Lesions: Iossifidis A et al. Acurracy of magnetic resonance arthrogam in recurrent shoulder instability. International Journal of Orthopaedics 2020; 7: 1366-1369
  CrossrefPubMedGoogle Scholar
• 34 Wahdan AA, Refaat M, El Kady L. et al. Role of ABER Positioning in Evaluation of Anteroinferior Labroligamentous Lesions in Shoulder MR Arthrograms. Suez Canal University Medical Journal 2021; 24: 87-92
  CrossrefPubMedGoogle Scholar
• 35 van Grinsven S, Hagenmaier F, van Loon CJ. et al. Does the experience level of the radiologist, assessment in consensus, or the addition of the abduction and external rotation view improve the diagnostic reproducibility and accuracy of MRA of the shoulder?. Clin Radiol 2014; 69: 1157-1164
  CrossrefPubMedGoogle Scholar
• 36 Shafiei M, Zadeh FS, Shafiee A. et al. Diagnostic performance of MRA in abduction and external rotation position in the detection of glenoid labral lesions: a systematic review and meta-analysis. Skeletal Radiol 2022; 51: 1611-1621
  CrossrefPubMedGoogle Scholar
• 37 Whiting PF, Rutjes AWS, WSestwood ME. et al. QUADAS-2: a revised tool for the qualitiy assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536
  CrossrefPubMedGoogle Scholar
• 38 Iyengar JJ, Burnett KR, Nottage WM. et al. The abduction external rotation (ABER) view for MRI of the shoulder. Orthopeadics 2010; 33: 562-565
  CrossrefPubMedGoogle Scholar
• 39 Sanders TG, Borders JJ, Mulloy JR. et al. Addition of the abduction and external rotation view during MR arthrography of the shoulder: increased sensitivitiy and confidence levels in the detection of anterior glenoid labral tears for readers at various levels of training. Radiology 2001; 221: 660
  PubMedGoogle Scholar
• 40 Marti-Bonmati. Evidence levels in radiology: the insights into imaging approach. Insights Imaging 2021; 12 (01) 45 DOI: 10.1186/s13244-021-00995-7.
  CrossrefPubMedGoogle Scholar