Clinical Imaging 48 (2018) 131–138

Contents lists available at ScienceDirect

Clinical Imaging
journal homepage: www.elsevier.com/locate/clinimag

Validity of radial magnetic resonance imaging to determine the extent of T

Bankart lesions☆,☆☆,☆☆☆,☆☆☆☆
Akiko Oguraa,1, Toru Moriharaa,1, Hiroyoshi Fujiwaraa,⁎, Yuji Araia, Yoshikazu Kidaa,
Hirotoshi Itob, Ryuhei Furukawaa, Yukichi Kabutoa, Tsuyoshi Sukenaria, Toshikazu Kuboa
a
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
b
Department of Radiology, Kajiicho Medical Imaging Center, Kyoto, Japan

A R T I C L E I N F O A B S T R A C T

Keywords: Purpose: The objectives were to compare conventional oblique coronal and axial images with radial images to
Bankart lesion determine the capacities of these modalities for visualizing sites in the glenoid labrum.
Glenoid labrum Materials and methods: The glenoid labra of 45 patients without a labrum injury and 30 patients with Bankart
Radial magnetic resonance imaging lesions were examined by magnetic resonance imaging using three different sections.
Results: The radial images permitted a greater range of assessment of the morphology of the glenoid labrum than
the conventional images.
Conclusion: Radial magnetic resonance imaging is a useful method for evaluation of the glenoid labrum and
enables wider visualization than conventional methods.

1. Introduction
The glenoid labrum frequently sustains injuries caused by sports
trauma or other accidents. Representative labrum injuries include su-
perior labrum anterior and posterior (SLAP) lesions and anteroinferior
glenoid labrum injuries associated with traumatic shoulder dislocation
(i.e., Bankart lesion). These lesions frequently cause discomfort to pa-
tients due to pain, impingement, and instability, and surgical treatment
is occasionally required. Symptoms vary based on the site and the type
of glenoid labrum injury. The surgical method selected for treatment
depends on the extent and type of the lesion.
Preoperative magnetic resonance imaging (MRI) can provide useful
information about the site and type of a labrum injury. In recent years,
the use of MRI instruments with a high magnetic field and magnetic
resonance (MR) arthrography has improved diagnostic accuracy [1–6];
however, some sites of the labrum are difficult to assess using these
conventional imaging methods [7–9]. Therefore, the assessment of the
extent of an injury has been insufficient. Preoperative assessments to
determine the extent of a labrum injury would enable more accurate
surgical planning [10]. Since March 2011, in addition to conventional
oblique coronal and axial imaging methods (i.e., conventional MRI), we
have used radial cross-sections (i.e., radial MRI) obtained using a 3.0 T
MR instrument to assess patients with rotator cuff injuries [11]. Radial
MRI may offer a good option for assessing the glenoid labrum, which is
circumferentially in contact with the glenoid margin. To confirm this
hypothesis, the capacities of conventional and radial MRI for the vi-
sualization of normal and injured anterior glenoid labra are compared
in this report. Moreover, arthroscopic findings are compared with these
MRI methods for assessing the extent of Bankart lesions. The purpose of
this study was to determine the usefulness of radial MRI for evaluating
the anterior glenoid labrum in comparison with conventional MRI.
2. Materials and methods
2.1. Patients without a labrum injury
The group of patients without a labrum injury included 45 in-
dividuals (representing 45 shoulders) who underwent MRI and ar-
throscopy for the repair of rotator cuff injuries between August 2011
and April 2014. These 45 patients included 24 men and 21 women with
a mean age of 58.8 years (age range 35–75 years). Patients in this group
were diagnosed by MRI as having rotator cuff injuries. Arthroscopy

☆
Support: none
☆☆
Disclaimer: none
☆☆☆
Ethical approval: the ethics committee of Kyoto Prefectural University of Medicine (Kyoto, Japan) approved this study (approval number, ERB-C-163).
☆☆☆☆
Level of evidence: level III, diagnostic study
⁎
Corresponding author at: Kajii-cho 465, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
E-mail addresses: toru4271@koto.kpu-m.ac.jp (T. Morihara), fjwr@koto.kpu-m.ac.jp (H. Fujiwara), y123arai@koto.kpu-m.ac.jp (Y. Arai), hito@koto.kpu-m.ac.jp (H. Ito).
1
These authors contributed equally to this work.

http://dx.doi.org/10.1016/j.clinimag.2017.10.009
Received 14 November 2016; Received in revised form 21 September 2017; Accepted 13 October 2017
0899-7071/ © 2017 Elsevier Inc. All rights reserved.
A. Ogura et al.
demonstrated no findings of injury to the glenoid labrum. The exclusion
criteria were as follows: (1) SLAP lesions, (2) previous shoulder surgery
on the affected shoulder, and (3) glenohumeral arthritis or in-
flammatory arthropathy of the affected shoulder. Seven patients were
excluded according to these criteria.
2.2. Patients with a labrum injury
The group of patients with a labrum injury included 30 individuals
(representing 30 shoulders) who underwent Bankart repair via arthro-
scopy between August 2011 and September 2014. These 30 patients
included 20 men and 10 women with a mean age of 25.2 years (age
range, 14–62 years). Patients in this group were diagnosed by MRI as
having anteroinferior glenoid labrum injuries. The arthroscopic find-
ings of these individuals demonstrated anteroinferior glenoid labrum
lesions. The exclusion criteria were as follows: (1) a previous shoulder
surgery on the affected shoulder, (2) glenohumeral arthritis or in-
flammatory arthropathy of the affected shoulder, and (3) deformity of
the glenoid labrum after glenoid fracture. Five patients were excluded
according to these criteria.
2.3. MRI protocol
An Achieva 3.0 T MR instrument (Philips Healthcare, Best, The
Netherlands) was used. Imaging was performed using a dedicated
shoulder coil (SENSE Flex M coil; Philips). Conventional images con-
sisted of oblique coronal and axial images. For the oblique coronal
images, the cross-section was established parallel to the scapula. For the
axial images, the cross-section was established across the glenoid
labrum. For the oblique sagittal images, the cross-section was estab-
lished parallel to the articular surface of the scapula. The conditions for
oblique coronal and axial imaging were as follows: fat-suppressed T2-
weighted fast-spin echo imaging [i.e., repetition time (TR), 4000 ms;
echo time (TE), 56 ms; echo train length (ETL), 17]; slice thickness,
3.0 mm; field of view, 150 mm × 150 mm; and acquisition matrix,
304 × 224 with a 512 × 512 reconstruction matrix. The conditions for
oblique sagittal imaging were the following: fat-suppressed T2-
weighted fast-spin echo imaging (TR, 5815 ms; TE, 100 ms; ETL, 16;
slice thickness, 3.0 mm; field of view, 150 mm × 150 mm; acquisition
matrix, 368 × 256 with a 512 × 512 reconstruction matrix).
For the radial cross-sections, the rotational axis was defined as the
line connecting the center of the glenoid cavity and the center of the
humeral head on the oblique sagittal plane. Twenty-four cross-sections
were established circumferentially at 7.5° intervals. The imaging con-
ditions were as follows: fat-suppressed T2-weighted fast-spin echo
imaging (i.e., TR, 4600 ms; TE, 61 ms; ETL, 17); slice thickness,
3.0 mm; field of view, 150 mm × 150 mm; and acquisition matrix,
304 × 224 with a 512 × 512 reconstruction matrix. Twenty-four
images were obtained during a period of approximately 4 min [11].
2.4. Evaluation of MR images
The glenoid labrum was assessed at the most superior part of the
junction of the long head tendon of the biceps brachii and the inferior
and anterior parts on the sagittal plane; these points were notated as
12:00, 6:00, and 3:00, respectively, based on their clock face positions
as referenced in previous studies (Fig. 1A) [12,13]. The 7.5 angles
formed between adjacent radial sections corresponded to 15 min on a
clock face. In the oblique coronal and axial images, the glenoid labrum
positions were calculated from the angles (α angle and β angle) formed
by the two lines: one is connected from the 12:00 site to the 6:00 site,
and the other connects the point where the cross-section contacts the
margin of the glenoid cavity to the center point of the glenoid cavity.
These positions were assessed according to a clock face (Fig. 1B, 1C).
For the patients without a labrum injury, images of the glenoid
labrum were assessed as follows: a labrum with a clear outline and
132
Clinical Imaging 48 (2018) 131–138
internal uniform low-signal intensity was deemed “clearly visible”
(Fig. 2A), whereas a labrum with an unclear outline or that lacked in-
ternal uniform, low-signal intensity was deemed “not clearly visible”
(Fig. 2B).
For those patients with a labrum injury, images of the glenoid
labrum were assessed as follows: a labrum with a clear outline was
deemed “clearly visible,” whereas a labrum with an unclear outline was
deemed “not clearly visible”. For the images classified as clearly visible,
the glenoid labrum was defined as “injured” if it demonstrated a clear
border of internal high-signal intensity in uniform low-signal intensity
(Fig. 2C) or there was an interruption of the continuity to the glenoid
bone (Fig. 2D).
2.4.1. Range of glenoid labrum visualization in patients without a labrum
injury
Radial, oblique coronal, and axial images were used to assess the
range of the anterior glenoid labrum that could be clearly visualized in
15-min intervals (in clock face terms). We also compared the range of
the glenoid labrum that could be visualized using conventionally ob-
tained and radial section images.
2.4.2. Range of Glenoid labrum visualization in patients with a labrum
injury
Radial, oblique coronal, and axial images were used to assess the
range of each anterior glenoid labrum lesion. We compared the range of
the injured glenoid labrum that could be visualized using con-
ventionally obtained and radial section images.
2.5. Surgical correlation
The average time between MR examination and arthroscopic sur-
gery was 30.2 days (range, 2–111 days). The surgeons preoperatively
evaluated the conventional and radial MR images of labrum-injured
patients. According to the arthroscopic findings from anterior and
posterior portals, a labrum that was detached from the glenoid was
determined to be a labrum injury. The extent of each glenoid labrum
injury in arthroscopic findings was assessed in 30-min intervals (in
clock face terms). Injured labra were found from 1:00 to 6:00.
2.6. Comparison of arthroscopic and MRI findings in patients with a labrum
injury
The sites of labrum injury assessed by radial, oblique coronal, and
axial images were compared in 30-min intervals (in clock face terms)
from 1:00 to 6:00. The sensitivity, specificity and accuracy for the
labrum injuries examined at each site were compared between con-
ventional and radial MR images.
2.7. Statistical analysis
For the clearly visualized normal and injured glenoid labra,
McNemar's test was used to compare differences at each site between
radial and conventional MRI. p values < 0.05 were considered statis-
tically significant. The Wilcoxon signed rank test was used to compare
differences in diagnostic performance between radial and conventional
MRI.
2.8. Intra- and inter-rater reliability
All MR images were evaluated twice over a 2-week interval by two
independent raters who were certified orthopedic surgeons specializing
in shoulder disorders. The raters were not informed about the diagnosis
or other conditions of the patients. If the results from the two observers
were inconsistent, a final consensus decision was obtained through
discussion between the two observers at a later date.
A. Ogura et al. Clinical Imaging 48 (2018) 131–138

A B C
C

12:00 α
α
β
A 3:00 P A P A P

6:00

Fig. 1. A—Radial section slice surface.

B—Oblique coronal section slice surface.
C—Axial section slice surface.
A = anterior; P = posterior.

Fig. 2. Assessments of radial MR images of glenoid labra.

“G” and “H” in the figure indicate the glenoid and humeral
head. Glenoid labra are defined by white circles. A, B:
labra without injury, A: a “clearly visible” labrum with a
clear outline and internal uniform, low-signal intensity, B:
a “not clearly visible” labrum with an unclear outline, C:
an “injured” labrum demonstrating a definite internal
high-signal intensity border, D: an “injured” labrum
showing an interruption of the continuity to the glenoid
bone. The white arrows indicate lesions of the injured
labrum.

2.9. Ethical considerations 1) 0.925 (95% CI, 0.848–0.963), indicating good inter-rater reliability.
The intraclass correlation coefficient was 0.98 for radial MR imaging
Ethical approval was obtained from the ethics committee of Kyoto and 0.94 for conventional MR imaging, indicating good intra-rater re-
Prefectural University of Medicine (Kyoto, Japan). liability.

3. Results 3.2. Range of glenoid labrum visualization in patients without a labrum

3.1. Reliability
With regard to the evaluation of labra on conventional MR images,
the interclass correlation coefficient (3, 1) was 0.987 (95% confidence
interval [CI], 0.974–0.994) and the interclass correlation coefficient (3,
injury
For the patients without a labrum injury, the glenoid labra were
clearly visualized in the following ranges: (1) from 12:00 to 6:00 in the
radial images, (2) from 12:00 to 1:00 and from 4:45 to 6:00 in the
oblique coronal images, and (3) from 1:00 to 4:45 in the axial images.

133
A. Ogura et al. Clinical Imaging 48 (2018) 131–138

Fig. 3. Percentage of cases determined as “clearly

Conventional Image site Radial Image visible” for each slice position from 12:00 to 6:00 in
12:00 patients without a labrum injury. The light gray bars
p=.001 12:15 indicate conventional MR images, and the dark gray
p=.000 12:30 bars indicate radial MR images.
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15 p=.003
3:30 p=.008
3:45 p=.000
4:00 p=.000
4:15 p=.000
4:30 p=.000
4:45 p=.000
5:00 p=.000
5:15 p=.000
5:30 p=.002
5:45
6:00

100 80 60 40 20 0 0 20 40 60 80 100
Percent (%) Percent (%)

Fig. 4. Percentage of cases determined as “clearly

Conventional Image Radial Image visible” for each slice position from 12:00 to 6:00
site
12:00 in patients with a labrum injury. The light gray
p=.003
12:15 bars indicate conventional MR images, and the
p=.000
12:30 dark gray bars indicate radial MR images.
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00 p=.003
3:15 p=.004
3:30 p=.000
3:45 p=.000
4:00 p=.000
4:15 p=.000
4:30 p=.000
4:45 p=.000
5:00 p=.000
5:15 p=.000
5:30 p=.000
5:45 p=.001
6:00

100 80 60 40 20 0 0 20 40 60 80 100

Percent (%) Percent (%)

In the radial images, the range from 2:30 to 6:00 was visualized in all
patients. In the conventional images, the sites at 2:45, 3:00, and 6:00
were visualized in all patients; however, the site at 4:30 was not vi-
sualized in any patient. Visualization of the range from 12:15 to 12:30
was inferior in the radial images compared to the conventional images;
however, the radial images yielded significantly better visualization for
the range from 3:15 to 5:30 compared with the conventional images
(p < 0.05) (Fig. 3).
3.3. Range of glenoid labrum visualization in patients with a labrum injury
the radial images; from 12:00 to 1:30, at 4:30, and at 6:00 in the ob-
lique coronal images; and from 1:30 to 4:00 in the axial images. In the
radial images, an assessment of the presence or absence of injury from
2:45 to 6:00 was possible in all patients. The radial images were inferior
to the conventional images at 12:00 and 12:15 however, from 3:00 to
5:45, the radial images yielded significantly better visualization than
the conventional images (p < 0.05) (Fig. 4).
3.4. Comparison of arthroscopic and MRI findings in patients with a labrum
injury

For the patients with a glenoid labrum injury, the maximum ranges In the arthroscopic findings, the most superior site of a glenoid
for injury assessment were from 12:00 to 12:45 and from 1:45 to 6:00 in labrum injury was 1:00, whereas the most inferior point was 6:00. The

134
A. Ogura et al. Clinical Imaging 48 (2018) 131–138

Fig. 5. Percentage of cases with a labrum injury assessed via MR

Conventional Image site Radial Image images compared with the percentage of labral injuries con-
firmed via arthroscopy in patients with a labrum injury, in-
1:00 dicating the sensitivities of conventional and radial MR images.
The light gray bars indicate the percentage based on conven-
1:30 tional MR images, and the dark gray bars indicate the percen-
tage based on radial MR images.
2:00 **Statistically significant difference at p < 0.01 between the
radial MR images and the conventional MR images.
2:30

3:00

3:30 **
4:00 **
4:30
**
5:00 **
5:30 **
6:00

100 80 60 40 20 0 0 20 40 60 80 100
Percent (%) Percent (%)

Table 1
Comparison of sensitivity, specificity and accuracy between radial images and conventional images.

Sensitivity Specificity Accuracy

Conventional Radial p value Conventional Radial p value Conventional Radial p value

Site of labrum Not injured Injured Prevalence rate

1:00 29 1 3.3 0.0 0.0 1.000 100.0 100.0 1.000 96.7 96.7 1.000
1:30 25 5 16.7 0.0 0.0 1.000 100.0 100.0 1.000 83.3 83.3 1.000
2:00 6 24 80.0 41.7 37.5 0.782 100.0 100.0 1.000 53.3 50.0 0.375
2:30 0 30 100.0 86.7 76.7 86.7 76.7 0.250
3:00 0 30 100.0 90.0 100.0 0.083 90.0 100.0 0.004
3:30 0 30 100.0 70.0 100.0 0.003 70.0 100.0 0.000
4:00 0 30 100.0 40.0 100.0 0.000 40.0 100.0 0.000
4:30 0 30 100.0 10.0 96.7 0.000 10.0 96.7 0.000
5:00 0 30 100.0 6.7 90.0 0.000 6.7 90.0 0.000
5:30 13 17 56.7 41.2 82.4 0.008 92.3 92.3 1.000 63.3 86.7 0.039
6:00 26 4 13.3 25.0 75.0 0.157 100.0 100.0 1.000 90.0 96.7 0.500

Statistically significant difference at p < 0.05 were indicated with the numbers emphasized by thick letters.

ranges in which glenoid labrum injury were assessed by MRI were from
2:00 to 6:00 in the radial images, from 4:30 to 6:00 in the oblique
coronal images, and from 2:00 to 5:00 in the axial images. Assessment
ability was different at various sites. Radial images were slightly in-
ferior to conventional images at 2:00 and 2:30, and clear visualization
of an injured labrum was possible from 3:00 to 4:00 in all patients. In
addition, radial images were superior to conventional images from 4:30
to 6:00. In particular, assessment by radial images was possible from
4:00 to 5:30 for nearly all patients. From 3:30 to 5:30, radial MR images
had significantly higher sensitivity (p < 0.01) for detecting labrum
injury than conventional MR images (Fig. 5, Table 1).
In the radial and conventional MR images, one false-positive case
was confirmed at 5:30; additional false-positive cases were not found.
The specificities for labrum injury in both types of image were 92.3% at
5:30 and 100% at all of sites except 5:30. From 3:00 to 5:00, the ac-
curacy of diagnosis of radial MR images for a labrum injury was higher
(p < 0.05) than the conventional MR image (Table 1).
In patients who had a Bankart lesion from 2:00 to 5:30 (Fig. 6), the
labrum was difficult to visualize clearly in oblique coronal images,
whereas an assessment of labrum injury using axial images was possible
only at 3:00. However, in the radial images, precise visualization of
labrum injury was possible at 3:00, 4:00, and 5:00 (Fig. 6B).
4. Discussion
When using MRI to diagnose injuries to the glenoid labrum, oblique
coronal and axial images have traditionally been employed. However,
assessments using these images require knowledge of the anatomy and
morphology of the glenoid labrum, which is attached circumferentially
to the pear-shaped glenoid cavity, and attachment morphology differs
according to site. The inferior labrum is closely fixed to the cartilage
with no gap, whereas the superior labrum is attached to the long head
tendon of the biceps brachii and is more flexible than the inferior
labrum [14]. The shape of the glenoid labrum can be visualized clearly
in cross-sections vertical to the glenoid margin. However, in cross-
sections oblique to the glenoid labrum, the partial volume effect causes
the shape of the labrum to become unclear, making assessment difficult
[11]. Using radial sections, the partial volume effect can be reliably
reduced in the glenoid labrum.
To the best of our knowledge, only two reports have referred to
radial MR images. In 1989, Munk et al. [15] referred to a preliminary
study regarding the use of radial sections to visualize the glenoid
labrum with MRI. Recently, Itoi et al. [16] used radial slice images
reconstructed from conventional MR imaging data to measure the dis-
placement and separation of Bankart lesions; therefore, our methods

135
A. Ogura et al. Clinical Imaging 48 (2018) 131–138

Fig. 6. A—A 25-year-old man with a glenoid labrum injury (a

A representative case). The arthroscopic findings show a Bankart
Arthroscopic Findings lesion from 2:00 to 5:30.
B—In the oblique coronal MR images, the areas at 3:00, 4:00,
and 5:00 are unclear; in the axial MR images, the injury is
clearly visible at 3:00 but is unclear at 4:00 and 5:00; in the
radial MR images, the injury is clearly visible at 3:00, 4:00, and
5:00. The upper side of each figure indicates the anterior di-
rection, and the left side of each figure indicates the medial
direction (G; glenoid, H; humeral head). The white arrows in-
dicate anteroinferior sites of the glenoid. The white arrowheads
indicate the outline of the glenoid labrum margin.

3:00
4:00

5:00

3:00 H
H G H
G G

4:00 H
H G H
G G

H
5:00
H
G G H G
Oblique Coronal Axial Radial

were different from theirs in the point of direction for cross-sections
circumferentially across the glenoid labrum.
In contrast, radial MRI has been applied to the acetabulum of the
hip joint, which is anatomically similar to the glenoid [11,17–21]. This
difference might depend on whether cross talk (i.e., slice overlapping
artifacts) between cross-sections is easily affected because the size of
the glenoid cavity is relatively small, and the intervals between con-
tiguous cross-sections in MRI are narrow. Therefore, it is difficult to
clearly assess the glenoid labrum and glenohumeral ligaments using
MRI.
MR equipment has improved in recent years. In the present study, a
high magnetic field device was used, which increased slice excitation
performance and enabled better selection of cross-sections. As such, 3-
mm cross-sections were utilized, which reduced crosstalk. These factors
may have improved the visualization of the glenoid labrum in the radial
images. Previously, our group examined the sites of rotator cuff inser-
tion by conventional and radial MR images and reported that radial MR
images were superior to conventional images for assessment to rotator
cuff tears [11,22].
In the present study, radial images enabled clear visualization of
two-thirds of the anterior glenoid labrum, whereas conventional images
enabled visualization of only one-third. Injuries to the glenoid labrum
ranged from the anterior to the inferior glenoid labrum and were
clearly visualized in radial images, whereas only the superior glenoid
labrum and part of the inferior glenoid labrum were visualized in
conventional images. Thus, the radial images permitted a greater range
of assessment of glenoid labrum morphology.
Potential reasons for the differences in the range of visualization of
normal and injured glenoid labra include the following: detachment of
the glenoid labrum resulting in an inferior shift in the injury group and
an increasing frequency of normal variants of superior shoulder
anatomy with age. For example, the prevalence of sublabral recess in-
creases with age and can be seen in 95% of cadavers aged 60–79 [12].
Additionally, the conventional and radial images were incapable of
providing clear visualization from 12:30 to 1:45, which could have
resulted from the presence of normal variants (e.g., an anterosuperior

136
A. Ogura et al.
3:00
4:00
5:00 6:00
Conventional images
Fig. 7. An 18-year-old male wrestler with shoulder instability after anterior dislocation of the shoulder joint who underwent repair of a humeral avulsion of a glenohumeral ligament
lesion via arthroscopy. Each radial MR image (3:00, 4:00, 5:00, and 6:00) shows clearer morphology of the avulsion than the corresponding conventional images. The white arrows
indicate anteroinferior sites of the glenoid.
sublabral foramen, an absent anterosuperior labrum, or the Buford
complex) or anatomical issues [4,14,21,23]. The contour of the glenoid
is aspherical, particularly in the anterosuperior region, and therefore
radial images tend to be suboptimal for evaluation of this area because
they intersect the substance of the labrum at an unfavorable obliquity.
Radial images enabled the precise assessment of injured glenoid
labra, except for those with injuries to the anterosuperior labrum, and
permitted a wider range of assessment of anteroinferior labrum mor-
phology and injury than conventional images. Additionally, the use of
radial imaging rather than conventional imaging in patients with a
labrum injury reduced the time required for imaging and permitted a
greater range of observation. Moreover, the full circumference of the
labrum was observed in the same imaging time and number of images
as imaging one-half of the circumferences. Therefore, careful observa-
tions made using radial MRI may lead to assessments of other lesions
via arthroscopy. Based on these findings, radial MRI can be applied to
evaluate glenoid labrum injuries and lesions that are not easily assessed
using conventional MRI (e.g., humeral avulsion of glenohumeral liga-
ment lesions) (Fig. 7).
There are several limitations to the present study. The surgeons
were not blinded to the MR images; therefore, their arthroscopic as-
sessments may have been biased. Additionally, this study only eval-
uated whether injured or uninjured labra were visible at each site.
Labral morphology, size, and degree of injury were not evaluated.
Finally, obtaining practical radial MR images, such as those assessed in
this study, requires a high-performance imaging instrument to reduce
crosstalk. Obtaining similar images using middle- or low-performance
imaging equipment could be performed using a slice angle > 7.5°.
In conclusion, radial MRI is useful for evaluating the anteroinferior
labrum and labral injuries, including Bankart lesions, and is more ac-
curate than conventional methods.
137
Clinical Imaging 48 (2018) 131–138
3:00
4:00
5:00 6:00
Radial images
Acknowledgments
None
References
[1] Magee T. Usefulness of unenhanced MRI and MR arthrography of the shoulder in
detection of unstable labral tears. AJR Am J Roentgenol 2015;205:1056–60. http://
dx.doi.org/10.2214/AJR.14.14262.
[2] Aydin N, Sirin E, Arya A. Superior labrum anterior to posterior lesions of the
shoulder: diagnosis and arthroscopic management. World J Orthop 2014;5:344–50.
http://dx.doi.org/10.5312/wjo.v5.i3.344.
[3] Beltran J, Rosenberg ZS, Chandnani VP, Cuomo F, Beltran S, Rokito A.
Glenohumeral instability: evaluation with MR arthrography. Radiographics
1997;17:657–73. http://dx.doi.org/10.1148/radiographics.17.3.9153704.
[4] Jana M, Gamanagatti S. Magnetic resonance imaging in glenohumeral instability.
World J Radiol 2011;3:224–32. http://dx.doi.org/10.4329/wjr.v3.i9.224.
[5] Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with
3.0-T MRI of the shoulder. AJR Am J Roentgenol 2006;187:1448–52. http://dx.doi.
org/10.2214/AJR.05.0338.
[6] Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid
labrum with 3-T MRI: is intraarticular contrast necessary? AJR Am J Roentgenol
2011;196:1139–44. http://dx.doi.org/10.2214/AJR.08.1734.
[7] Chandnani VP, Yeager TD, DeBerardino T, Christensen K, Gagliardi JA, Heitz DR,
et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthro-
graphy, and CT arthrography. AJR Am J Roentgenol 1993;161:1229–35. http://dx.
doi.org/10.2214/ajr.161.6.8249731.
[8] Phillips JC, Cook C, Beaty S, Kissenberth MJ, Siffri P, Hawkins RJ. Validity of
noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-
posterior tears. J Shoulder Elbow Surg 2013;22:3–8. http://dx.doi.org/10.1016/j.
jse.2012.03.013.
[9] Sasaki T, Yodono H, Prado GL, Saito Y, Miura H, Itabashi Y, et al. Increased signal
intensity in the normal glenoid labrum in MR imaging: diagnostic pitfalls caused by
the magic-angle effect. Magn Reson Med Sci 2002;1:149–56. http://dx.doi.org/10.
2463/mrms.1.149.
[10] Jana M, Srivastava DN, Sharma R, Gamanagatti S, Nag HL, Mittal R, et al. Magnetic
resonance arthrography for assessing severity of glenohumeral labroligamentous
lesions. J Orthop Surg (Hong Kong) 2012;20:230–5.
[11] Furukawa R, Morihara T, Arai Y, Ito H, Kida Y, Sukenari T, et al. Diagnostic ac-
curacy of magnetic resonance imaging for subscapularis tendon tears using radial-
slice magnetic resonance images. J Shoulder Elbow Surg 2014;23:e283–90. http://
A. Ogura et al.
dx.doi.org/10.1016/j.jse.2014.03.011.
[12] Li X, Lin TJ, Jager M, Price MD, Deangelis NA, Busconi BD, et al. Management of
type II superior labrum anterior posterior lesions: a review of the literature. Orthop
Rev (Pavia) 2010;2:e6http://dx.doi.org/10.4081/or.2010.e6.
[13] Tuite MJ, Currie JW, Orwin JF, Baer GS, del Rio AM. Sublabral clefts and recesses in
the anterior, inferior, and posterior glenoid labrum at MR arthrography. Skeletal
Radiol 2013;42:353–62. http://dx.doi.org/10.1007/s00256-012-1496-0.
[14] Cooper DE, Arnoczky SP, O'Brien SJ, Warren RF, DiCarlo E, Allen AA. Anatomy,
histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint
Surg Am 1992;74:46–52.
[15] Munk PL, Holt RG, Helms CA, Genant HK. Glenoid labrum: preliminary work with
use of radial-sequence MR imaging. Radiology 1989;173(3):751. http://dx.doi.org/
10.1148/radiology.173.3.2813781.
[16] Itoi E, Kitamura T, Hitachi S, Hatta T, Yamamoto N, Sano H. Arm abduction pro-
vides a better reduction of the bankart lesion during immobilization in external
rotation after an initial shoulder dislocation. Am J Sports Med 2015;43:1731–6.
http://dx.doi.org/10.1177/0363546515577782.
[17] Kubo T, Horii M, Harada Y, Noguchi Y, Yutani Y, Ohashi H, et al. Radial-sequence
magnetic resonance imaging in evaluation of acetabular labrum. J Orthop Sci
1999;4:328–32. http://dx.doi.org/10.1007/s007760050112.
138
Clinical Imaging 48 (2018) 131–138
[18] Horii M, Kubo T, Hachiya Y, Nishimura T, Hirasawa Y. Development of the acet-
abulum and the acetabular labrum in the normal child: analysis with radial-se-
quence magnetic resonance imaging. J Pediatr Orthop 2002;22:222–7.
[19] Horii M, Kubo T, Hirasawa Y. Radial MRI of the hip with moderate osteoarthritis. J
Bone Joint Surg Br 2000;82:364–8. http://dx.doi.org/10.1302/0301-620X.82B3.
9923.
[20] Kubo T, Horii M, Yamaguchi J, Inoue S, Fujioka M, Ueshima K, et al. Acetabular
labrum in hip dysplasia evaluated by radial magnetic resonance imaging. J
Rheumatol 2000;27:1955–60.
[21] Yoon LS, Palmer WE, Kassarjian A. Evaluation of radial-sequence imaging in de-
tecting acetabular labral tears at hip MR arthrography. Skeletal Radiol
2007;36:1029–33. http://dx.doi.org/10.1007/s00256-007-0363-x.
[22] Honda H, Morihara T, Arai Y, Horii M, Ito H, Furukawa R, et al. Clinical application
of radial magnetic resonance imaging for evaluation of rotator cuff tear. Orthop
Traumatol Surg Res 2015;101:715–9. http://dx.doi.org/10.1016/j.otsr.2015.06.
007.
[23] Robinson G, Ho Y, Finlay K, Friedman L, Harish S. Normal anatomy and common
labral lesions at MR arthrography of the shoulder. Clin Radiol 2006;61:805–21.
http://dx.doi.org/10.1016/j.crad.2006.06.002.