SLAP tears: Diagnosis using 3-T shoulder MR arthrography with the 3D isotropic turbo spin-echo space sequence versus conventional 2D sequences

Objectives: The aim of this study was to determine the accuracy and reliability of shoulder magnetic resonance (MR) arthrography with three-dimensional (3D) isotropic intermediate-weighted turbo spin-echo (TSE) sampling perfection with application-optimised contrasts using different flip angle evolution (SPACE) in the diagnosis of superior labrum anterior-to- posterior (SLAP) lesions compared with two-dimensional (2D) TSE at 3.0 T. Methods: MR arthrograms, including 2D TSE and 3D TSE-SPACE, in 87 patients who underwent arthroscopy were retrospectively analysed by two reviewers for the presence and type of SLAP lesions. Sensitivity and specificity were compared using McNemar's test, and inter-observer agreement was calculated using Cohen's kappa. Receiver operating characteristic (ROC) curve analyses were performed. Results: The mean sensitivity, specificity and accuracy were 90%, 85% and 86% for 2D TSE, and 81%, 86% and 85% for 3D TSE-SPACE respectively, with no statistically significant differences. Inter-observer agreements were substantial in 2D TSE (κ = 0.76) and 3D TSE-SPACE (κ = 0.68). The areas under the ROC curves were 0.92 for 2D TSE and 0.90 for 3D TSE-SPACE, which were not significantly different. Conclusions: MR arthrography with 3D TSE-SPACE showed comparable accuracy and substantial inter-observer agreement for the diagnosis of SLAP lesions Key Points: • MR arthrography is regarded as the definitive method of shoulder imaging • Different MR sequences are evolving for SLAP lesions • 3D TSE-SPACE demonstrated comparable overall accuracy to 2D TSE for SLAP lesions • But more false-negative interpretations occurred using 3D TSE-SPACE • Further technical improvement is necessary before 3D TSE-SPACE replaces 2D TSE sequences