MRI vs MRI Arthrogram for possible labral hip tear?

For what it's worth, I have a shoulder labrum tear which was diagnosed with an MRI arthrogram.

First off, I am not a Dr. But, I just had an arthrogram and the radiologist explained that it was the only means of accurately depicting the cartilage. Said that the dye shows up around the edges of the tear. My Doc was the opposite of yours and insisted on the arthrogram. Hope that helps.

I'm an infectious disease specialist, so only deal with joints when they are infected (a reason not to get the arthrogram...), but I think you and your doc are probably both partially correct. With older scanners (1.5 Tesla) arthrogram has clearly been shown to be superior, but the new scanners (3 T and higher) have narrowed the gap. Have they closed it? Not sure anyone knows, since the studies are sort of cumbersome- you need to get both scans, then go look in the hip (either with a full open procedure, or with an arthroscope) as the "gold standard."

Below is an abstract describing one small such study, which would seem to support your doc. Older studies back you up more.

Radiology. 2006 Feb;238(2):706-11.

Evaluation of the acetabular labrum at 3.0-T MR imaging compared with 1.5-T MR arthrography: preliminary experience.

Sundberg TP, Toomayan GA, Major NM.

Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.

Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. The purpose of this study was to prospectively compare imaging of the acetabular labrum with 3.0-T magnetic resonance (MR) imaging and 1.5-T MR arthrography. Eight patients (four male, four female; mean age, 38 years) with hip pain suspicious for labral disease were examined at both MR arthrography and MR imaging. Presence of labral lesions, paralabral cysts, articular cartilage lesions, subchondral cysts, osteophytes, and synovial herniation pits was recorded. There was arthroscopic correlation of findings in five patients. MR imaging depicted four surgically confirmed labral tears that were identified at MR arthrography, as well as one that was not visualized at MR arthrography. MR imaging helped identify all other pathologic conditions that were diagnosed at MR arthrography and helped identify one additional surgically confirmed focal articular cartilage lesion. These results provide encouraging support for evaluation with 3.0-T MR imaging over 1.5-T MR arthrography. (c) RSNA, 2006

PMID: 16436825 [PubMed - indexed for MEDLINE]

+1 on the artho for a shoulder labral tear. FYI, that is a BIG needle and they left mine in while they took an xray to make sure the needle was in the right location. Not near as much fun as I was expecting....I'd make sure my glutes were good and strong and there was no other option prior to further med tests....

Thx everyone.

i had MRIs with and without dye and xrays and it still took 5 docs to find my hip labral tear...don't give up!

I am a Radiologists who specializes in MRI.

Long story short:

MRI without arthrogram is only about 30-40% sensitive in detection of acetabular (hip) labral tears.

Sensitivity with arthrogram is in the low 90s with specificity also in the 90s.

Get the arthrogram.

To answer the ID guy above. The chance of infection is exceedingly low. I've done hundreds of arthrograms over my 20 year career and have never had one get infected.

Like you, I had a hip MRI that came back clean did not show a labral tear.

But, when I went back for an MRI arthrogram, a labral tear *was* clearly shown.

For what it's worth, my plain hip MRI was in a 3T. My arthrogram was in a 1.2T and even with the smaller magnet, the tear was still clearly shown because of the injected dye. The dye provides the diagnostic benefit more than the size of the magnet does... (Best case scenario I suppose, would be 1) dye, and 2) the biggest magnet, a 3T.)

Everyone, thanks for your help. FWIW, I had the MRI arthrogram today...should get the results soon.

I just wanted to follow up on my MRI arthrogram. I indeed have a labral tear, which did not show up on the regular MRI. They also found some arthritic degeneration and, surprisingly, a possible inguinal hernia on the opposite side. When it rains, it pours...lol