[Sportschosun Jang Jong-ho reporter] The main causes of shoulder pain include rotator cuff tears and superior labral lesions. The rotator cuff is a bundle of four muscles and tendons that surrounds the shoulder joint and is responsible for lifting and rotating the arm. When these tendons are damaged by repetitive motion, trauma, or aging, severe pain can develop and it becomes difficult to raise the arm. A superior labral lesion is a tear in the upper part of the cartilage rim that stabilizes the shoulder joint. It often occurs in athletes and workers who repeatedly use their arms overhead, such as baseball and badminton players.
Both conditions require early and accurate diagnosis to lead to proper treatment. However, patients have faced burdens because precise evaluation of soft tissues such as tendons and cartilage requires Magnetic Resonance Imaging (MRI), or repeated CT scans that involve radiation exposure. In this context, a domestic medical team has demonstrated the effectiveness of low-dose CT arthrography, which greatly reduces radiation exposure while maintaining high diagnostic accuracy.
This was confirmed in a paper by the team led by Professor Choi Jeong-a of the Department of Radiology at Hallym University Dongtan Sacred Heart Hospital, titled 'Usefulness of low dose (LD) CT arthrography (CTA) of the shoulder in diagnosis of rotator cuff pathology and SLAP lesions: comparison with standard dose (SD) CTA and correlation with MRI.'
For detailed diagnosis of shoulder disorders, 3T MRI, a high-end magnetic resonance imaging system with excellent resolution, is mainly used. However, the test is expensive, takes a long time, and cannot be performed on patients with claustrophobia or those who have metal implants such as pacemakers.
To address this limitation, CT arthrography has also been used, but concerns over radiation exposure have remained despite its strong diagnostic performance.
To improve patient safety, the research team introduced 'low-dose CT arthrography,' a technique that minimizes radiation exposure during imaging, and conducted a study on 60 patients suspected of having shoulder disorders. The patients were divided into two groups, standard-dose CT (25 patients) and low-dose CT (35 patients), and the diagnostic accuracy of both methods was compared using 3T MRI results as the reference standard.
The results showed that when the low-dose protocol was applied, the radiation exposure received by patients fell by about 31%, from 4.80 mGy to 3.29 mGy. In particular, despite the substantial reduction in radiation dose, background noise that can interfere with image clarity was significantly lower in the low-dose scans (11.04 HU) than in the standard-dose scans (16.21 HU), making it possible to obtain cleaner and more precise images.
Based on these high-quality images, diagnostic accuracy was measured, and the low-dose CT scans showed diagnostic performance equivalent to that of the standard-dose CT when evaluated against MRI.
In diagnosing rotator cuff tears, the most common cause of shoulder pain, low-dose CT showed a sensitivity of 53.8% and a specificity of 100%, outperforming the standard-dose scan, which had a sensitivity of 40% and a specificity of 100%.
A superior labral lesion is a condition in which the upper part of the cartilage labrum that stabilizes the shoulder joint is torn, causing pain especially when the arm is raised overhead. In diagnosing superior labral lesions as well, low-dose CT showed a sensitivity of 88% and a specificity of 80%, demonstrating high accuracy comparable to the standard-dose scan, which recorded 93.7% sensitivity and 66.7% specificity.
This study is significant in that it presents a new clinical standard that allows patients to receive accurate and safe diagnoses while easing concerns about radiation exposure.
Professor Choi Jeong-a said, "Through this study, we demonstrated that low-dose CT arthrography is an innovative alternative that can achieve both patient safety through reduced radiation exposure and maintained diagnostic accuracy in the diagnosis of shoulder joint disorders." She added, "We will continue to research and actively introduce patient-centered, safe, and precise imaging technologies to help reduce medical costs for patients and improve treatment outcomes."
The findings were published online in June in 'Skeletal Radiology,' an international SCIE-indexed journal in the field of musculoskeletal radiology.
Jang Jong-ho, Sportschosun, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
