Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK
Although subspecialist orthopaedic surgeons usually request Magnetic Resonance Arthrogram (MRA) examinations, some orthopaedic surgeons may request this examination for a body part that is different from their subspecialty. The purpose of the study is to compare the MRA and the clinical findings in the subspecialist and non-subspecialist groups.
Retrospective analysis of MRA examinations over a 6-month period. Findings were compared with the clinical information.
There were 144 examinations (69 shoulder, 42 wrist and 33 hip). 85% of these were subspecialist referrals; 60% of them showed findings compatible with the clinical diagnosis. 15% of the MRA examinations were non-subspecialist referrals; 52% of them correlated with the clinical findings.
Overall, clinical information agreed with MRA findings for shoulder labral tears, hip labral tears and wrist triangular fibrocartilage complex tears in 63.3%, 64.5% and 61.5% respectively. The subspecialist group were more accurate than the non-subspecialist group in diagnosing hip labral tears (68% vs. 50%) and triangular fibrocartilage complex tears (62.5% vs. 50%). On the contrary, shoulder MRA and clinical findings correlated better in the non-subspecialist group (77.8%) compared to the subspecialist group (63.3%). However, the small number of requests generated by the non-subspecialist group may affect the results. Suspected scapholunate ligament injury showed low correlation with MRA at 26.7% (33.3% in the subspecialist group and 0% in the non-subspecialist group).
Generally, the clinical findings are more accurate in the subspecialist referrals when compared to MRA findings and therefore a subspecialist referral is preferred. The low agreement between clinically suspected scapholunate ligament injuries and wrist MRA probably reflects the relative difficulty in establishing this diagnosis clinically.
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