Signs of SLAP lesions.

In summary, two-thirds of type 2, 3, or 4 SLAP tears can be identified on T2-weighted images with moderately good interobserver reliability by using the two MR signs of high signal intensity in the posterior one-third of the labrum and an irregular or laterally curved area of high signal intensity. In our study, the specificity of these two signs for the correct identification of a normal superior labrum, including that in shoulders with a superior recess, was 74%–84%. The double Oreo cookie sign was uncommon and did not improve the sensitivity of T2-weighted images for the diagnosis of SLAP tears.

Figure 1. Normal-variant superior recess at arthroscopy in a 42-year-old man. Oblique coronal T2-weighted MR image (2,000/90 [repetition time msec/echo time msec]) shows an area of medial curving high signal intensity (arrow) at the junction of the labrum with the glenoid hyaline cartilage. The patient also has a complete rotator cuff tear.

Figure 2. Type 3 SLAP tear at arthroscopy in a 41-year-old man. Three consecutive oblique coronal T2-weighted images (2,000/90) with the greatest craniocaudal sections of the glenoid fossa from the posterior (left image) to anterior (right image) regions demonstrate an area of high signal intensity in the labrum (arrow) extending to the articular surface on the posterior image. The patient was also judged by both observers to have two high-signal-intensity lines (arrowhead).

Figure 3. Type 2 SLAP tear at arthroscopy in a 28-year-old man. Oblique coronal, fast spin-echo T2-weighted image (2,200/88 [effective]) with fat suppression shows a laterally curving linear area of high signal intensity (arrow) within the labrum.

Figure 4. Type 3 SLAP tear at arthroscopy in a 24-year-old man. Oblique coronal, fast spin-echo T2-weighted image (2,200/88 [effective]) with fat suppression shows two high-signal-intensity lines (ie, double Oreo cookie sign) (arrowheads) in the superior labrum; the more lateral line (large arrowhead) represents the SLAP tear. The patient was also judged by both observers to have irregular high signal intensity.

Reference