ACR good/bad

[admin]

When a specialist told me that my three-year old daughter was dislocated I had both an MRI and a CT Scan done.

The MRI showed "atrophy of the right shoulder girdle" and the CT scan showed "posterior dislocation". Had I not gotten the CT scan I wouldn't have believed the physician and wouldn't have gotten my daughter treated for her dislocation.

By the way, the specialist only prescribed the MRI. I took it upon myself (because another mom contacted me) to get the CT scan done, too. Thank God I did.

[m&mmom]

Guest,
Matthew's procedure was an arthroscopic surgery. I can't speak for every case but when Matthew had his surgery there was an eight year old patient there also and that child's surgery was done an arthoscopic surgery as well. I would ask a few surgeons who perform the surgery this question and I would think they could provide you with accurate information.

Cindy

[katep]

Krista,

As I recall, you took barium prior to the CT scan? CT scan will also show blood vessels if they are injected with "contrast" containing radioactive isotopes. A CT myelogram can also be used to look for avulsions. The contrast is injected into the spinal canal and mixes with the spinal fluid. If there are avulsions, they can be detected because you can see where the spinal fluid is "leaking out". But again, you aren't actually seeing nerves or blood - you are seeing the contrast media.

There have been plenty of papers that have used CT scans of young children's shoulders. As I said, many authors started out using it, but since have switched to MRI. The CT scan pictures and MRI pictures are not even comparable. In the CT scan pictures, you *maybe* can see the ossification "center" in the middle of the humeral ball - it looks like a tiny ball floating in space - but the rest is invisible. In order to use CT scan for measurement in the shoulder, you need to extrapolate from the ossified portions. An MRI clearly shows everything.

If anyone is interested, I would be happy to send you pictures from a paper showing CT scans for children younger than five, and one showing MRI scans.

Kate

[katep]

Here's an article on CT scan and the use of contrast to visualize organs, the spinal canal and blood. If you inject the blood, the organs that have a good blood exchange (like the brain) will also show up because they accumulate the isotope. Cartilage, ligaments and tendons don't rapidly exchange blood, so a contrast is not helpful to visualize them.

http://imaginis.com/ct-scan/contrast.asp

I wish I could post pictures showing the difference between the CT scans people have taken of shoulders and MRI scans. The CT scans show *maybe* a shadowy outline of the whole humerus (if the child is not too young) but the MRI shows amazing detail.

Again, I would be happy to email anyone who is interested.

Kate

[katep]

guest,

I'm incredulous that a doctor could miss a posterior dislocation on an MRI. It was clear as day on our son's, and all the others I've seen. Did the MRI report contain anything about glenoid version or PHHA (percentage humeral head anterior to glenoid fossa)?

Kate

[admin]

I also wanted to say (which I failed to write in my previous post) that my daugther only had an MRI prior to her shoulder surgery. The MRI clearly showed her shoulder was subluxing. Post op, she also had an MRI (one year later) and it shows her shoulder is doing extremely well. The CTSCAN that I had WAS mostly looking at organs and to see what this mass was...come to find out, the mass didn't even show up on the CTSCAN so an ultrasound was ordered. So yes, an MRI is perfectly fine when looking for information on the shoulder joint in my opinion. At least it was for us.
~Krista~

[admin]

Sorry Kate...I missed your question...
YES, I did take barium prior to the scan.
~Krista~

[admin]

the mri report only said those words about atrophy, nothing more

the next mri report two years later said "normal shoulder" and if you saw the scan that would have shocked you, too

[admin]

Look at Dr. Nath's weblog for a great explanation of ACR.
http://www.drnathbrachialplexus.com/weblog/index.php

[admin]

You will get a MUCH different explanation of this surgery if you ask Dr Waters or Dr Kozin. If you are thinking about having this surgery for your child, please ask several different doctors, and most importantly, the doctors that are doing this surgery all of the time. Some doctors swear by this surgery and disagree with other procedures. Just remember, there are two sides to every story, and in this case, two very different explanations and outlooks for this type of surgery.
~Krista~