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Peeters NHC, van der Kraats AM, van der Krieken TE, van Iersel D, Janssen ERC, Heerspink FOL. The validity of ultrasound and shear wave elastography to assess the quality of the rotator cuff. Eur Radiol 2024; 34:1971-1978. [PMID: 37646806 PMCID: PMC10873448 DOI: 10.1007/s00330-023-10037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/12/2023] [Accepted: 06/17/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES US with shear wave elastography (SWE) could reduce the burden and costs of the diagnostic process for patients with rotator cuff disorders. The aim of this study is to investigate the validity of US and SWE in preoperative assessment of fatty infiltration (FI) and muscle atrophy of the supraspinatus (SSP) and infraspinatus (ISP) muscles. METHODS Patients with a rotator cuff disorder and a recent shoulder CT or MRI scan were eligible to participate. Goutallier and Warner stages of the SSP and ISP muscle were measured on the scan, for assessment of FI and muscle atrophy, respectively. These findings were compared with shear wave velocities (SWVs) assessed on US. Visual assessment of FI on US was compared with the Goutallier stage. To quantify the amount of muscle atrophy, the occupation ratio between SSP fossa and muscle was measured on MRI and US. RESULTS Seventy-eight shoulders were included in the analysis. The correlation found between the occupation ratio on US and Warner and Goutallier stage and ratio on MRI ranged between r = - 0.550 to 0.589. The Goutallier stage of ISP and SSP muscle assessed on US showed a fair correlation with the Goutallier stage on a scan of r = 0.574 and r = 0.582, respectively. There was a poor correlation between the SWVs and scan results (r = - 0.116 to 0.07). CONCLUSION SWE is not a valid method to measure the amount of FI or muscle atrophy in the SSP muscle. Therefore, SWE is not a suitable alternative for MRI in standard preoperative diagnostics in rotator cuff pathologies. CLINICAL RELEVANCE STATEMENT Shear wave elastography should not be used in the diagnostics of rotator cuff pathologies. KEY POINTS • There is a fair correlation between the Goutallier stage of the supraspinatus and infraspinatus muscle assessed on MRI and CT and visual assessment of fatty infiltration achieved on US. • Shear wave elastography is not a valid tool for the determination of the amount of fatty infiltration or muscle atrophy. • Shear wave elastography should not be used as a cheaper and less burdensome alternative for diagnostics in rotator cuff pathologies.
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Affiliation(s)
- Nina H C Peeters
- Department of Radiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Annick M van der Kraats
- Department of Orthopaedic Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | | | - Dave van Iersel
- Department of Radiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Esther R C Janssen
- Department of Orthopaedic Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
- Department of Orthopaedic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Yao J, Chepelev L, Nisha Y, Sathiadoss P, Rybicki FJ, Sheikh AM. Evaluation of a deep learning method for the automated detection of supraspinatus tears on MRI. Skeletal Radiol 2022; 51:1765-1775. [PMID: 35190850 DOI: 10.1007/s00256-022-04008-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if deep learning is a feasible approach for automated detection of supraspinatus tears on MRI. MATERIALS AND METHODS A total of 200 shoulder MRI studies performed between 2015 and 2019 were retrospectively obtained from our institutional database using a balanced random sampling of studies containing a full-thickness tear, partial-thickness tear, or intact supraspinatus tendon. A 3-stage pipeline was developed comprised of a slice selection network based on a pre-trained residual neural network (ResNet); a segmentation network based on an encoder-decoder network (U-Net); and a custom multi-input convolutional neural network (CNN) classifier. Binary reference labels were created following review of radiologist reports and images by a radiology fellow and consensus validation by two musculoskeletal radiologists. Twenty percent of the data was reserved as a holdout test set with the remaining 80% used for training and optimization under a fivefold cross-validation strategy. Classification and segmentation accuracy were evaluated using area under the receiver operating characteristic curve (AUROC) and Dice similarity coefficient, respectively. Baseline characteristics in correctly versus incorrectly classified cases were compared using independent sample t-test and chi-squared. RESULTS Test sensitivity and specificity of the classifier at the optimal Youden's index were 85.0% (95% CI: 62.1-96.8%) and 85.0% (95% CI: 62.1-96.8%), respectively. AUROC was 0.943 (95% CI: 0.820-0.991). Dice segmentation accuracy was 0.814 (95% CI: 0.805-0.826). There was no significant difference in AUROC between 1.5 T and 3.0 T studies. Sub-analysis showed superior sensitivity on full-thickness (100%) versus partial-thickness (72.5%) subgroups. DATA CONCLUSION Deep learning is a feasible approach to detect supraspinatus tears on MRI.
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Affiliation(s)
- Jason Yao
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada.
| | - Leonid Chepelev
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Yashmin Nisha
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Paul Sathiadoss
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman Street, Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Adnan M Sheikh
- Department of Radiology, The University of British Columbia Faculty of Medicine, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Comparison of CAIPIRINHA-accelerated 3D fat-saturated-SPACE MRI with 2D MRI sequences for the assessment of shoulder pathology. Eur Radiol 2021; 32:593-601. [PMID: 34258637 DOI: 10.1007/s00330-021-08183-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/20/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the performance of 6-min MRI with a fat-saturated 3D-controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) Sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) TSE protocol with 10-min 2D TSE MRI protocol for assessment of abnormalities of the shoulder. METHODS Forty-nine subjects underwent both 3D fat-saturated-CAIPIRINHA SPACE and 2D TSE sequences of the shoulder on a 3.0-T system. Following randomization and anonymization, two musculoskeletal radiologists evaluated the 2D and 3D images independently for image quality and diagnostic capability. Descriptive statistics, inter-observer, and inter-method concordance were investigated. p values < 0.05 were considered significant. RESULTS For image quality assessment, 2D images were similar to 3D CAIPIRINHA SPACE images (p = 0.05). 3D had lower noise standard deviation (SD) and higher fluid CNR than 2D images (p = 0.00). For diagnostic capability assessment, using 2D TSE as a standard of reference, sensitivity, specificity, and accuracy of 3D SPACE were, respectively, 94.81%, 94.12%, and 94.39% for tendon abnormalities; 97.06%, 80.00%, and 91.84% for acromioclavicular joint abnormalities; 88.89%, 100.00%, and 93.89% for adjacent bone alterations; and 97.30%, 100%, and 97.96% for joint fluid/effusion assessment. The inter-method concordance was moderate to almost perfect. The inter-observer-concordance of the shoulder assessment was also moderate to almost perfect, with SSP lesions demonstrating the greatest concordance. CONCLUSIONS The performance of 6-min 3D fat-saturated-CAIPIRINHA SPACE MRI for shoulder MRI is similar to that of 10-min 2D TSE MRI. 3D fat-saturated-CAIPIRINHA SPACE MRI can be utilized to reduce scan time without degradation in image quality. KEY POINTS • CAIPIRINHA acceleration 3D fat-saturated-MRI of the shoulder is achievable in 6 min with high spatial resolution. • 3D fat-saturated CAIPIRINHA MRI is similar to 2D MRI in the shoulder assessment. • 3D CAIPIRINHA MRI images enable rapid diagnosis of shoulder abnormalities without image quality degradation.
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Shoulder tenderness was associated with the inflammatory changes on magnetic resonance imaging in patients with rheumatoid arthritis. Sci Rep 2019; 9:19599. [PMID: 31862930 PMCID: PMC6925129 DOI: 10.1038/s41598-019-55938-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 12/02/2019] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to assess the association between the shoulder tenderness and the inflammatory changes on magnetic resonance imaging (MRI) in the rheumatoid shoulder. Forty-one shoulders of 41 patients with rheumatoid arthritis (RA) were examined. We evaluated synovitis, erosion and bone marrow edema, by counting the numbers of each positive site, and rotator cuff tears on shoulder MRI. The association between the shoulder tenderness and the MRI findings were statistically analyzed. Twenty-three of 41 patients had tenderness in the shoulder joints. There were 20 shoulders (48.8%) with rotator cuff tear, and no significant difference was observed in the prevalence of rotator cuff tear between the tenderness group and non-tenderness group (p = 0.080). There were no significant differences in the demographic data between these two groups. In MRI findings, we found significant difference for the synovitis (p = 0.001) and bone marrow edema (p = 0.021). Synovitis was strongly associated with the shoulder tenderness (OR: 3.996, 95% CI: 1.651-9.671). Synovitis was the factor most associated with shoulder tenderness.
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MR imaging of the shoulder in youth baseball players: Anatomy, pathophysiology, and treatment. Clin Imaging 2019; 57:99-109. [DOI: 10.1016/j.clinimag.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
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Kim MJ, Park KS, Seo AR, Lee SI, Ha YC, Yoo JI. Determining functional activity profiles in patients with upper extremity disorders: is there effect modification by hand-grip strength? Clin Interv Aging 2018; 13:2351-2358. [PMID: 30532525 PMCID: PMC6241862 DOI: 10.2147/cia.s187066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The purposes of this study were to investigate the effect of hand-grip strength (HGS) on the Disabilities of the Arm, Shoulder, and Hand (DASH) score in women with upper extremity musculoskeletal disorders (UEMDs) living in rural communities and examine whether upper extremity diseases affected upper extremity functional activity in each group (normal/low HGS) and whether grip strength (GS) was an effect modifier in upper extremity functional activity. Methods A total of 239 women older than 60 years who had completed a medical workup for epicondylitis, rotator cuff tears, and/or hand osteoarthritis were included in the final study. Functional activity was assessed by DASH, and muscle strength was measured by GS. Low HGS was defined according to the Asian Working Group for Sarcopenia (HGS <18 kg in women). Pearson correlation analysis was performed to evaluate the relationship between HGS and the DASH score. A multiple regression analysis was performed after defining DASH as a dependent variable and dividing subjects into two groups (low HGS and normal HGS). Statistical analyses were performed using SPSS Statistics V.24. Results HGS in the participants correlated with the DASH score (r=−0.320, P<0.001). In the low HGS group, waist circumference (B=−0.526, P=0.010) and the DASH score were significantly correlated. In addition, DASH scores were statistically significantly increased as the number of upper extremity diseases increased to 2 (B=11.592, P=0.016) and 3 (B=15.716, P=0.001). The DASH score in the normal HGS group was correlated with the Patient Health Questionnaire-2 score (β=2.680, P<0.001) after adjusting covariates. Conclusion We found that HGS in UEMD patients affected health-related quality of life as measured by the DASH. Maintaining hand muscle strength may improve patient functional activity in age-related UEMDs.
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Affiliation(s)
- Mi-Ji Kim
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, ,
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, ,
| | - Ae-Rim Seo
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, ,
| | - Sang-Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jun-Il Yoo
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, , .,Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea,
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Moon DK, Park YJ, Song SY, Kim MJ, Park JS, Nam DC, Kim DH, Na JB, Lee SI, Hwang SC, Park KS. Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas. Yonsei Med J 2018; 59:669-676. [PMID: 29869465 PMCID: PMC5990682 DOI: 10.3349/ymj.2018.59.5.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Jin Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Youn Song
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dae Cheol Nam
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Hee Kim
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Boem Na
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
| | - Ki Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
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Hasegawa A, Mihata T, Yasui K, Kawakami T, Itami Y, Neo M. Intra- and Inter-rater Agreement on Magnetic Resonance Imaging Evaluation of Rotator Cuff Integrity After Repair. Arthroscopy 2016; 32:2451-2458. [PMID: 27318780 DOI: 10.1016/j.arthro.2016.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the intra- and inter-rater agreement of magnetic resonance imaging (MRI) evaluations of rotator cuff integrity at 6 and 24 months after arthroscopic rotator cuff repair (ARCR). METHODS Three shoulder surgeons reviewed 68 MRI scans from 34 patients who had undergone ARCR and MRI examination at both 6 and 24 months after surgery. Postoperative rotator cuff integrity was investigated by using Owen, Sugaya, and Hayashida classifications to determine whether the rotator cuff was intact or whether there was a partial-thickness retear or full-thickness retear and Burks score to assess tendon appearance. Multirater kappa statistics were used to measure intra- and inter-rater agreement. Kappa values were interpreted according to guidelines adapted from the work of Landis and Koch. RESULTS All classifications had similar intra- and inter-rater agreement (κ = 0.14 to 0.67, 0.23 to 0.60, respectively), but no intra- or inter-rater agreement scored "excellent." Inter-rater agreement after ARCR was higher at 24 months (κ = 0.31 to 0.60) than at 6 months (κ = 0.23 to 0.44) in all evaluations. Reviewers identified full-thickness retears with a moderate to good degree of inter-rater agreement in all evaluations, at both 6 months (κ = 0.42 to 0.73) and 24 months (κ = 0.61 to 0.80) after ARCR. However, poor inter-rater agreement (κ = 0.13 to 0.19) was found in the identification of partial-thickness retears in all evaluations at 6 months after ARCR. CONCLUSIONS Shoulder surgeons showed better intra- and inter-rater agreement in predicting full-thickness tears compared with partial-thickness tears. The inter-rater agreement at 24 months after ARCR was superior to that at 6 months in predicting not only full-thickness retear but also partial-thickness retear. MRI evaluation of rotator cuff integrity at 6 months after ARCR may be less reliable, regardless of which classification system is used. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kenji Yasui
- Department of Orthopedic Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Takeshi Kawakami
- Department of Orthopedic Surgery, Shiroyama Hospital, Osaka, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Yonemoto Y, Okamura K, Kobayashi T, Kaneko T, Okura C, Suto T, Tachibana M, Tsushima Y, Takagishi K. Predictive factors related to shoulder joint destruction in rheumatoid arthritis patients treated with biologics: A prospective study. Mod Rheumatol 2016; 27:587-592. [PMID: 27785938 DOI: 10.1080/14397595.2016.1245125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to assess the risk factors for shoulder joint destruction in rheumatoid arthritis (RA) patients treated with biologics. METHODS Thirty shoulders of 29 patients with RA were assessed using 18F-fluorodeoxyglucose positron emission tomography (PET) and magnetic resonance imaging (MRI) before starting biologics and 6 months later. The mean age (range) was 54 (18-72) years, and the mean disease duration was 7 (0.8-30) years. The radiographic findings were assessed at baseline and 3 years later. The inflammation markers and RA disease activity were also assessed. These parameters were compared between the progression of joint destruction group and the no progression group. RESULTS The SUVmax on PET, the rate of synovitis, and the rate of rotator cuff tear on MRI before biologic treatment were significantly higher in the progression of joint destruction group. SUVmax and synovitis on MRI after 6 months were also significantly higher in the progression of joint destruction group. On logistic regression analysis, the SUV at baseline of the shoulder joint was the main risk factor for joint destruction. CONCLUSION The detection of synovitis by imaging was more important than disease activity and inflammation markers for assessing the progression of shoulder joint destruction.
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Affiliation(s)
- Yukio Yonemoto
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Koichi Okamura
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Tsutomu Kobayashi
- b Department of Physical Therapy, Faculty of Health Care , Takasaki University of Health and Welfare , Takasaki , Gunma , Japan
| | - Tetsuya Kaneko
- c Department of Orthopaedic Surgery , Inoue Hospital , Takasaki , Gunma , Japan , and
| | - Chisa Okura
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Takahito Suto
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Masahiro Tachibana
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Yoshito Tsushima
- d Department of Diagnostic Radiology and Nuclear Medicine , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Kenji Takagishi
- a Department of Orthopaedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
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Ganal E, Ho CP, Wilson KJ, Surowiec RK, Smith WS, Dornan GJ, Millett PJ. Quantitative MRI characterization of arthroscopically verified supraspinatus pathology: comparison of tendon tears, tendinosis and asymptomatic supraspinatus tendons with T2 mapping. Knee Surg Sports Traumatol Arthrosc 2016; 24:2216-24. [PMID: 25739912 DOI: 10.1007/s00167-015-3547-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/18/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Quantitative MRI T2 mapping is a non-invasive imaging technique sensitive to biochemical changes, but no studies have evaluated T2 mapping in pathologic rotator cuff tendons. It was sought to evaluate the efficacy of T2 mapping in detecting differences in the supraspinatus tendon (SST) among patients with tendinosis, partial tears and minimally retracted full-thickness tears, relative to asymptomatic volunteers. METHODS The pathologic cohort consisted of two arthroscopically verified groups: tendinosis and a tear group of partial tears or minimally retracted full-thickness tears, and was compared to an asymptomatic cohort with no prior history of shoulder pathology. The SST was manually segmented from the footprint to the medial humeral head in the coronal and sagittal planes and divided into six clinically relevant subregions. Mean T2 values and inter- and intra-rater reliability were assessed. RESULTS In the anterolateral subregion, the tear group exhibited significantly higher mean T2 values (43.9 ± 12.7 ms) than the tendinosis (34.9 ± 3.9 ms; p = 0.006) and asymptomatic (33.6 ± 5.3 ms; p = 0.015) groups. In the posterolateral subregion, the tear group had higher mean T2 values (45.2 ± 13.7) than the asymptomatic group (34.7 ± 6.7; p = 0.012). Inter- and intra-rater reliability was mostly excellent (ICC > 0.75). CONCLUSION T2 mapping is an accurate non-invasive method to identify quantitatively early rotator cuff pathology. The lateral region in the coronal plane in particular may differentiate partial and small minimally retracted full-thickness tears from tendinosis and asymptomatic tendons. Understanding and being able to measure quantitatively the process of tendon degeneration and subsequent tearing may help clinicians to better predict at-risk groups and to stratify treatment options. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Edmund Ganal
- The Steadman Clinic, 181 W Meadow Dr, Suite 400, Vail, CO, 81657, USA
| | - Charles P Ho
- Steadman Philippon Research Institute, 181 W Meadow Dr, Vail, CO, 81657, USA
| | - Katharine J Wilson
- Steadman Philippon Research Institute, 181 W Meadow Dr, Vail, CO, 81657, USA
| | - Rachel K Surowiec
- Steadman Philippon Research Institute, 181 W Meadow Dr, Vail, CO, 81657, USA
| | - W Sean Smith
- Steadman Philippon Research Institute, 181 W Meadow Dr, Vail, CO, 81657, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, 181 W Meadow Dr, Vail, CO, 81657, USA
| | - Peter J Millett
- The Steadman Clinic, 181 W Meadow Dr, Suite 400, Vail, CO, 81657, USA.
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13
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Abstract
Synopsis Tendinopathy is frequently associated with structural disorganization within the tendon. As such, the clinical use of ultrasound and magnetic resonance imaging for tendinopathy has been the focus of numerous academic studies and clinical discussions. However, similar to other musculoskeletal conditions (osteoarthritis and intervertebral disc degeneration), there is no direct link between tendon structural disorganization and clinical symptoms, with findings on imaging potentially creating a confusing clinical picture. While imaging shows the presence and extent of structural changes within the tendon, the clinical interpretation of the images requires context in regard to the features of pain and the aggravating loads. This review will critically evaluate studies that have investigated the accuracy and sensitivity of imaging in the detection of clinical tendinopathy and the methodological issues associated with these studies (subject selection, lack of a robust gold standard, reliance on subjective measures). The advent of new imaging modalities allowing for the quantification of tendon structure or mechanical properties has allowed new critical insight into tendon pathology. A strength of these novel modalities is the ability to quantify properties of the tendon. Research utilizing ultrasound tissue characterization and sonoelastography will be discussed. This narrative review will also attempt to synthesize current research on whether imaging can predict the onset of pain or clinical outcome, the role of monitoring tendon structure during rehabilitation (ie, does tendon structure need to improve to get a positive clinical outcome?), and future directions for research, and to propose the clinical role of imaging in tendinopathy. J Orthop Sports Phys Ther 2015;45(11):842-852. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5880.
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14
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Honda H, Morihara T, Arai Y, Horii M, Ito H, Furukawa R, Kida Y, Sukenari T, Ikoma K, Oda R, Yamada Y, Fujiwara H, Kubo T. Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear. Orthop Traumatol Surg Res 2015; 101:715-9. [PMID: 26315347 DOI: 10.1016/j.otsr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 04/06/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Magnetic resonance imaging is useful for evaluating the rotator cuff, but some tendinous insertions cannot be assessed using oblique sagittal, oblique coronal, and axial magnetic resonance (MR) images because of the presence of the partial volume effect. HYPOTHESIS The purpose of this study was to determine whether radial-slice MR images could reveal normal rotator cuff insertions and rotator cuff tears more clearly than conventional MR images. PATIENTS AND METHODS The study included 18 subjects with normal rotator cuffs and 30 with rotator cuff tears. MR images of rotator cuff insertions sliced into radial, oblique coronal, and axial sections were obtained. The extent to which normal rotator cuff insertions and rotator cuff tears were visualized in each of the three MR images was evaluated. RESULTS The top to posterior portions of the rotator cuff insertions from 0° to 120° could be visualized in the radial MR images. In comparison, the posterior portions of the rotator cuff insertions could not be visualized around 45° in both the oblique coronal and axial MR images. DISCUSSION These findings demonstrate that radial MR images are superior to the oblique coronal and axial MR images regarding their ability to accurately visualize rotator cuff insertions. Radial MR images also revealed greater detail around 45° in the posterior area of the rotator cuff tears than the oblique coronal and axial MR images. Radial MR images are particularly useful for visualizing clinically important posterosuperior rotator cuff tears. LEVEL OF EVIDENCE Level III - Diagnostic study.
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Affiliation(s)
- H Honda
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - T Morihara
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Y Arai
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - M Horii
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - H Ito
- Department of radiology, Kajiicho medical imaging center, Kyoto, Japan
| | - R Furukawa
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Y Kida
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - T Sukenari
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - K Ikoma
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - R Oda
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Y Yamada
- Laboratory of sports and health science, Kyoto Prefectural university of medicine, Kyoto, Japan
| | - H Fujiwara
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan.
| | - T Kubo
- Department of orthopaedics, graduate school of medical science, Kyoto Prefectural university of medicine, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
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15
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Furukawa R, Morihara T, Arai Y, Ito H, Kida Y, Sukenari T, Horii M, Ikoma K, Fujiwara H, Kubo T. Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. J Shoulder Elbow Surg 2014; 23:e283-90. [PMID: 24927884 DOI: 10.1016/j.jse.2014.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/20/2014] [Accepted: 03/29/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging has low diagnostic accuracy for subscapularis tendon tears. This study investigated the utility of radial-slice magnetic resonance images for diagnosing subscapularis tendon tears. MATERIALS AND METHODS We investigated 55 shoulders in 54 patients with rotator cuff tears evident during arthroscopic shoulder surgery. The intraoperative finding of a subscapularis tendon tear was compared with the identification of a subscapularis tendon tear on preoperative radial, transverse, and oblique sagittal images using a 3.0-T system. The sensitivity and specificity of diagnostic images generated using different imaging methods for subscapularis tendon tears were investigated. RESULTS A subscapularis tendon tear was present in 38 shoulders (69.1%). When the diagnostic accuracy of the magnetic resonance images was compared with the arthroscopic findings, the radial images had 94.7% sensitivity and 82.4% specificity, the transverse images had 57.9% sensitivity and 100% specificity, and the oblique sagittal images had 60.5% sensitivity and 100% specificity. CONCLUSION Radial-slice magnetic resonance images have high sensitivity for subscapularis tendon tears and are useful for diagnosing these lesions. In particular, the sensitivity for tears in the superior part of the subscapularis tendon is higher than that of conventional methods.
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Affiliation(s)
- Ryuhei Furukawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Morihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotoshi Ito
- Department of Radiology, Kajiicho Medical Imaging Center, Kyoto, Japan
| | - Yoshikazu Kida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuyoshi Sukenari
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motoyuki Horii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Abstract
Rotator cuff pathology accounts for most presentations of shoulder pain to primary care clinics. History and physical examination are important for excluding other causes of shoulder pain, while imaging assists in confirming the diagnosis and defining the severity of the abnormality. Treatment options include nonsteroidal anti-inflammatory agents, subacromial corticosteroid injections, and exercise therapy. Surgical intervention is generally reserved for those failing nonoperative measures and/or healthy, young, and middle-aged adults with full-thickness rotator cuff tears. No surgical technique has proved to be superior. Despite surgery, about 20% of patients experience retears, more likely occurring in those with larger tears.
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Affiliation(s)
- Viviane Bishay
- Department of Family Medicine, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608, USA.
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17
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Kloth JK, Winterstein M, Akbar M, Meyer E, Paul D, Kauczor HU, Weber MA. Comparison of 3D turbo spin-echo SPACE sequences with conventional 2D MRI sequences to assess the shoulder joint. Eur J Radiol 2014; 83:1843-9. [PMID: 25082477 DOI: 10.1016/j.ejrad.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/20/2014] [Accepted: 06/16/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the accuracy and reliability of three-dimensional (3D) T1- and proton density (PD)-weighted turbo spin-echo (TSE) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) compared with conventional 2D sequences in assessment of the shoulder-joint. MATERIALS AND METHODS Ninety-three subjects were examined on a 3-T MRI system with both conventional 2D-TSE sequences in T1-, T2- and PD-weighting and 3D SPACE sequences in T1- and PD-weighting. All examinations were assessed independently by two reviewers for common pathologies of the shoulder-joint. Agreement between 2D- and 3D-sequences and inter-observer-agreement was evaluated using kappa-statistics. RESULTS Using conventional 2D TSE sequences as standard of reference, sensitivity, specificity, and accuracy values of 3D SPACE were 81.8%, 95.1%, and 93.5% for injuries of the supraspinatus-tendon (SSP), 81.3%, 93.5%, and 91.4% for the cartilage layer and 82.4%, 98.5%, and 97.5% for the long biceps tendon. Concordance between 2D and 3D was almost perfect for tendinopathies of the SSP (κ=0.85), osteoarthritis (κ=1), luxation of the biceps tendon (κ=1) and adjacent bone marrow (κ=0.92). Inter-observer-agreement was generally higher for conventional 2D TSE sequences (κ, 0.23-1.0), when compared to 3D SPACE sequences (κ, -0.33 to 1.0) except for disorders of the long biceps tendon and supraspinatus tendon rupture. CONCLUSION Because of substantial and almost perfect concordance with conventional 2D TSE sequences for common shoulder pathologies, MRI examination-time can be reduced by nearly 40% (up to 11 min) using 3D-SPACE without loss of information.
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Affiliation(s)
- Jost Karsten Kloth
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
| | - Marianne Winterstein
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
| | - Michael Akbar
- Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
| | | | | | - Haus-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
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18
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Tawfik AM, El-Morsy A, Badran MA. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report? World J Radiol 2014; 6:274-283. [PMID: 24976930 PMCID: PMC4072814 DOI: 10.4329/wjr.v6.i6.274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/07/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.
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19
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Anz AW, Lucas EP, Fitzcharles EK, Surowiec RK, Millett PJ, Ho CP. MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions. Eur J Radiol 2014; 83:801-5. [PMID: 24613548 DOI: 10.1016/j.ejrad.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/16/2013] [Accepted: 02/03/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE Diagnosis of partial rotator cuff tears and tendonopathy using conventional MRI has proven variable. Quantitative T2 mapping may have application for assessing rotator cuff health. In order to evaluate the usefulness of T2 mapping for the rotator cuff, methods must be refined for mapping the supraspinatus tendon, and normative T2 values must first be acquired. MATERIALS AND METHODS This study was IRB approved. Thirty asymptomatic volunteers (age: 18-62) were evaluated with sagittal and coronal T2 mapping sequences. Manual segmentation of tendon and muscle as a unit and tendon alone was performed twice by two independent raters. Segmentations were divided into medial, middle and lateral subregions and mean T2 values calculated. RESULTS Anatomic comparison of mean T2 values illustrated highest values in the medial region, lowest values in the lateral region, and intermediate values for the middle region upon coronal segmentation (p<0.001). In sagittal segmentations, there were higher values in the medial region and no significant differences between the lateral and middle subregions. No significant differences were found with comparison across age groups. Inter and intra-rater segmentation repeatability was excellent, with coefficients ranging from 0.85 to 0.99. CONCLUSION T2 mapping illustrated anatomic variation along the supraspinatus muscle-tendon unit with low standard deviations and excellent repeatability, suggesting that changes in structure due to degeneration or changes associated with healing after repair may be detectable.
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Affiliation(s)
- Adam W Anz
- The Steadman Clinic, Vail, CO, United States.
| | - Erin P Lucas
- Steadman Philippon Research Institute, Vail, CO, United States.
| | | | | | | | - Charles P Ho
- Steadman Philippon Research Institute, Vail, CO, United States.
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20
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Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NCA, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013; 2013:CD009020. [PMID: 24065456 PMCID: PMC6464715 DOI: 10.1002/14651858.cd009020.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shoulder pain is a very common symptom. Disorders of the rotator cuff tendons due to wear or tear are among the most common causes of shoulder pain and disability. Magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US) are increasingly being used to assess the presence and size of rotator cuff tears to assist in planning surgical treatment. It is not known whether one imaging method is superior to any of the others. OBJECTIVES To compare the diagnostic test accuracy of MRI, MRA and US for detecting any rotator cuff tears (i.e. partial or full thickness) in people with suspected rotator cuff tears for whom surgery is being considered. SEARCH METHODS We searched the Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, and LILACS from inception to February 2011. We also searched trial registers, conference proceedings and reference lists of articles to identify additional studies. No language or publication restrictions were applied. SELECTION CRITERIA We included all prospective diagnostic accuracy studies that assessed MRI, MRA or US against arthroscopy or open surgery as the reference standard, in people suspected of having a partial or full thickness rotator cuff tear. We excluded studies that selected a healthy control group, or participants who had been previously diagnosed with other specific causes of shoulder pain such as osteoarthritis or rheumatoid arthritis. Studies with an excessively long period (a year or longer) between the index and reference tests were also excluded. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study characteristics and results of included studies, and performed quality assessment according to QUADAS criteria. Our unit of analysis was the shoulder. For each test, estimates of sensitivity and specificity from each study were plotted in ROC space and forest plots were constructed for visual examination of variation in test accuracy. Meta-analyses were performed using the bivariate model to produce summary estimates of sensitivity and specificity. We were unable to formally investigate potential sources of heterogeneity because of the small number of studies. MAIN RESULTS We included 20 studies of people with suspected rotator cuff tears (1147 shoulders), of which six evaluated MRI and US (252 shoulders), or MRA and US (127 shoulders) in the same people. Many studies had design flaws, with the potential for bias, thus limiting the reliability of their findings. Overall, the methodological quality of the studies was judged to be low or unclear. For each test, we observed considerable heterogeneity in study results, especially between studies that evaluated US for the detection of full thickness tears and studies that evaluated MRA for the detection of partial thickness tears. The criteria for a positive diagnostic test (index tests and reference standard) varied between studies.Meta-analyses were not possible for studies that assessed MRA for detection of any rotator cuff tears or partial thickness tears. We found no statistically significant differences in sensitivity or specificity between MRI and US for detecting any rotator cuff tears (P = 0.13), or for detecting partial thickness tears (P = 1.0). Similarly, for the comparison between MRI, MRA and US for detecting full thickness tears, there was no statistically significant difference in diagnostic performance (P = 0.7). For any rotator cuff tears, the summary sensitivity and specificity were 98% (95% CI 92% to 99%) and 79% (95% CI 68% to 87%) respectively for MRI (6 studies, 347 shoulders), and 91% (95% CI 83% to 95%) and 85% (95% CI 74% to 92%) respectively for US (13 studies, 854 shoulders). For full thickness tears, the summary sensitivity and specificity were 94% (95% CI 85% to 98%) and 93% (95% CI 83% to 97%) respectively for MRI (7 studies, 368 shoulders); 94% (95% CI 80% to 98%) and 92% (95% CI 83% to 97%) respectively for MRA (3 studies, 183 shoulders); and 92% (95% CI 82% to 96%) and 93% (95% CI 81% to 97%) respectively for US (10 studies, 729 shoulders).Because few studies were direct head-to-head comparisons, we could not perform meta-analyses restricted to these studies. The test comparisons for each of the three classifications of the target condition were therefore based on indirect comparisons which may be prone to bias due to confounding. AUTHORS' CONCLUSIONS MRI, MRA and US have good diagnostic accuracy and any of these tests could equally be used for detection of full thickness tears in people with shoulder pain for whom surgery is being considered. The diagnostic performance of MRI and US may be similar for detection of any rotator cuff tears. However, both MRI and US may have poor sensitivity for detecting partial thickness tears, and the sensitivity of US may be much lower than that of MRI. The strength of evidence for all test comparisons is limited because most studies were small, heterogeneous and methodologically flawed, and there were few comparative studies. Well designed studies that directly compare MRI, MRA and US for detection of rotator cuff tears are needed.
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Affiliation(s)
- Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentAv. Albert Einstein, 627/701São PauloSao PauloBrazilCEP 05651‐901
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Nigel CA Hanchard
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughTees ValleyUKTS1 3BA
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783‐5th FloorSão PauloSão PauloBrazil
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Contreras F, Brown HC, Marx RG. Predictors of success of corticosteroid injection for the management of rotator cuff disease. HSS J 2013; 9:2-5. [PMID: 24426836 PMCID: PMC3640713 DOI: 10.1007/s11420-012-9316-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection. METHODS During a 12-month period, consecutive patients with rotator cuff disease were analyzed. Patients received subacromial CSI, oral NSAIDs, and physical therapy. Baseline ASES score, simple shoulder test, an activity scale, and demographic data were recorded. Patients who remained symptomatic and were indicated for surgery were considered failures. Patients that did not undergo surgery were reassessed after a minimum of 1 year. RESULTS Forty-nine patients met our criteria. Follow-up was obtained for 81.6%. Sixteen cases (40%) failed conservative treatment at final follow-up (22.4 ± 11 months). CSI were successful in 76.2% of males and 45% of females (p = 0.04). Full-thickness tears were present in 8% of the patients with symptom resolution and 25% of those that failed conservative treatment (p = 0.29). No significant difference was found in age, hand dominance, duration of symptoms, or any of the scoring systems. CONCLUSION It is difficult to predict outcomes after CSI. Our treatment strategy showed a 40% failure rate.
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Affiliation(s)
- Fernando Contreras
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Apartado 99-1000 San José, San José, Costa Rica
| | - Haydée C. Brown
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Robert G. Marx
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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22
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Abstract
MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease.
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Affiliation(s)
- R J Hodgson
- Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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23
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La Rocca Vieira R, Rybak LD, Recht M. Technical update on magnetic resonance imaging of the shoulder. Magn Reson Imaging Clin N Am 2012; 20:149-61, ix. [PMID: 22469396 DOI: 10.1016/j.mric.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improvement in both hardware and software has opened up new opportunities in magnetic resonance (MR) imaging of the shoulder. MR imaging at 3-T has become a reality, with the prospect of 7-T imaging on the horizon. The art of MR arthrography continues to improve, aided by the use of novel imaging positions. New techniques for three-dimensional imaging, the reduction of metal artifact, and biochemical imaging of cartilage hold great promise.
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Affiliation(s)
- Renata La Rocca Vieira
- Department of Radiology, New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA.
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24
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Hitachi S, Takase K, Tanaka M, Tojo Y, Tabata S, Majima K, Higano S, Takahashi S. High-resolution magnetic resonance imaging of rotator cuff tears using a microscopy coil: noninvasive detection without intraarticular contrast material. Jpn J Radiol 2011; 29:466-74. [PMID: 21882088 DOI: 10.1007/s11604-011-0583-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 03/01/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) using a microscopy coil for the diagnosis of rotator cuff tears by comparing the method to conventional MRI and MRI arthrography. MATERIALS AND METHODS A total of 68 shoulders were prospectively studied using a 1.5-T MRI unit. Conventional MRI scans were obtained with a surface coil and high-resolution MRI scans with a microscopy coil. MRI arthrography was performed in 28 shoulders using a surface coil. MRI evaluation of tears of rotator cuff tendons was compared with arthroscopic findings and surgical results. RESULTS The surgery revealed 40 full-thickness tears, 13 partial-thickness tears, and 15 intact cuffs. In all, 35 (88%) full-thickness tears were correctly diagnosed on conventional MRI and 40 (100%) on high-resolution MRI. MR arthrography delineated 11 of 12 (92%) full-thickness tears. Altogether, 5 (38%) of the partial-thickness tears were detected on conventional MRI, and 12 (92%) were clearly demonstrated on high-resolution MRI. MRI arthrography depicted three (60%) of five partial-thickness tears. High-resolution MRI showed higher sensitivity than conventional MRI (P < 0.05) and had values equivalent to those of MRI arthrography for diagnosing partial-thickness tears. CONCLUSION High-resolution MRI with a microscopy coil is a feasible, noninvasive technique for diagnosing rotator cuff tears.
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Affiliation(s)
- Shin Hitachi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 981-8574, Japan.
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Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg 2011; 20:537-42. [PMID: 21440460 DOI: 10.1016/j.jse.2011.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/22/2010] [Accepted: 01/01/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND Evaluate the accuracy for shoulder magnetic resonance imaging (MRI) interpretations of typical community radiologists and compare this to selected fellowship trained musculoskeletal radiologists. METHODS The MRIs of 104 shoulders of 100 consecutive different patients who had undergone shoulder arthroscopy by a single surgeon were included in this prospective study. The 104 typed MRI reports of community radiologists were examined, and the positive or negative findings were recorded for the anterior, superior, and posterior labra, and the long head biceps tendon and rotator cuff. The 104 MRIs were then interpreted by 2 fellowship trained musculoskeletal radiologists who were blinded to the nature of this study. They were asked to specifically comment on the same shoulder pathologies and to subjectively rate the quality of each MRI study using a visual analogue score (VAS). RESULTS The shoulder pathologies documented by arthroscopy included rotator cuff tears (55 full, 10 partial), labral tears (12 anterior, 17 posterior, 29 superior), and 31 biceps abnormalities. There were 69 noncontrast MRIs and 35 MRI arthrograms. Comparing the community radiologists' accuracies with the 2 selected musculoskeletal radiologists' accuracies, there were no significant differences for any of the shoulder pathologies studied. There was a significant positive correlation between VAS and accuracies for both musculoskeletal radiologists in diagnosing posterior labral tears only. The use of contrast in these MRIs only significantly improved both of the musculoskeletal radiologists' accuracies in diagnosing biceps lesions. CONCLUSION The accuracies for shoulder MRI in this community setting were not improved by having the MRIs interpreted by selected fellowship trained musculoskeletal radiologists.
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Bildgebung vor und nach arthroskopischen Eingriffen an der Schulter. ARTHROSKOPIE 2011. [DOI: 10.1007/s00142-011-0638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bencardino JT, Beltran LS. Pain related to rotator cuff abnormalities: MRI findings without clinical significance. J Magn Reson Imaging 2010; 31:1286-99. [PMID: 20512880 DOI: 10.1002/jmri.22145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
MRI has become an important diagnostic tool in the evaluation of rotator cuff pathology and the technology continues to evolve. Direct MR arthrography, diagnosis-specific sequencing such as fat suppression, special positioning such as abducted externally rotated (ABER) views and ultra high field magnets allow for an unprecedented level of detail in imaging. In this article, we review MRI findings in patients with rotator cuff abnormalities that are anatomic variants or incidental findings. Although MRI findings may be diagnostic in some cases, we find that clinical correlation with history and physical examination is critical to differentiate between anatomic variants, incidental findings, and true pathology. We conclude that good communication between the orthopedic surgeon and the radiologist is necessary to optimize diagnostic yield.
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Kang CH, Kim SS, Kim JH, Chung KB, Kim YH, Oh YW, Jeong WK, Kim BH. Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation. Skeletal Radiol 2009; 38:1063-9. [PMID: 19543893 DOI: 10.1007/s00256-009-0734-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 05/29/2009] [Accepted: 06/01/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. MATERIALS AND METHODS In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (<1 cm), medium (1-3 cm), and large (>3 cm). RESULTS The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. CONCLUSION Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears.
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Affiliation(s)
- Chang Ho Kang
- Department of Radiology, Kangwon National University Hospital, Kangwon-do, Korea
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Clinical Significance of Intramuscular Cysts in the Rotator Cuff and Their Relationship to Full- and Partial-Thickness Rotator Cuff Tears. AJR Am J Roentgenol 2009; 192:719-24. [DOI: 10.2214/ajr.07.3727] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Diagnostic imaging in a patient with shoulder pain should be used only after a comprehensive clinical evaluation of the shoulder. X-ray and ultrasonography are the basic diagnostic tools; computed tomography and magnetic resonance imaging (MRI) should be used only with certain indications. Ultrasonography and MRI have comparable accuracy for identifying and measuring full-thickness rotator cuff tears, but the accuracy for identifying partial-thickness still needs to be improved. MR arthrography has significantly improved sensitivity and specificity for partial-thickness tears of the cuff. Only ultrasound provides a real-time examination tool during shoulder movements. Moreover, dynamic ultrasonography can assess the contraction patterns of the supraspinatus and infraspinatus muscles, which may improve decision making in the treatment of shoulder diseases. In depicting fatty atrophy of the supraspinatus and infraspinatus muscles, MRI remains the reference standard. MRI should not be used as a diagnostic screening tool in patients with chronic shoulder pain because it does not appear to significantly affect treatment or outcome.
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Affiliation(s)
- A Hedtmann
- Orthopädische Abteilung Klinik Fleetinsel Hamburg, Admiralitätstrasse 3, 20249 Hamburg, Deutschland.
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Spencer EE, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, Ma CB, Jones G, Safran M, Holloway GB, Kuhn JE. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med 2008; 36:99-103. [PMID: 17932406 DOI: 10.1177/0363546507307504] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although magnetic resonance imaging (MRI) is a standard method of assessing the extent and features of rotator cuff disease, the authors are not aware of any studies that have assessed the interobserver agreement among orthopaedic surgeons reviewing MRI scans for rotator cuff disease. HYPOTHESIS Fellowship-trained orthopaedic shoulder surgeons will have good interobserver agreement in predicting the more salient features of rotator cuff disease such as tear type (full thickness versus partial thickness), tear size, and number of tendons involved but only fair agreement with more complex features such as muscle volume, fat content, and the grade of partial-thickness cuff tears. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Ten fellowship-trained orthopaedic surgery shoulder specialists reviewed 27 MRI scans of 27 shoulders from patients with surgically confirmed rotator cuff disease. The ability to interpret full-thickness versus partial-thickness tears, acromion type, acromioclavicular joint spurs or signal changes, biceps lesions, size and grade of partial-thickness tears, acromiohumeral distance, number of tendons involved and amount of retraction for full-thickness tears, size of full-thickness tears, and individual muscle fatty infiltration and atrophy were assessed. Surgeons completed a standard evaluation form for each MRI scan. Interobserver agreement was determined and a kappa level was derived. RESULTS Interobserver agreement was highest (>80%) for predicting full- versus partial-thickness tears of the rotator cuff, and for quantity of the teres minor tendon. Agreement was slightly less (>70%) for detecting signal in the acromioclavicular joint, the side of the partial-thickness tear, the number of tendons involved in a full-thickness tear, and the quantity of the subscapularis and infraspinatus muscle bellies. Agreement was less yet (60%) for detecting the presence of spurs at the acromioclavicular joint, a tear of the long head of the biceps tendon, amount of retraction of a full-thickness tear, and the quantity of the supraspinatus. The best kappa statistics were found for detecting the difference between a full- and partial-thickness rotator cuff tear (0.77), and for the number of tendons involved for full-thickness tears (0.55). Kappa for predicting the involved side of a partial-thickness tear was 0.44; for predicting the grade of a partial-thickness tear, it was -0.11. CONCLUSIONS Fellowship-trained, experienced orthopaedic surgeons had good agreement for predicting full-thickness rotator cuff tears and the number of tendons involved and moderate agreement in predicting the involved side of a partial-thickness rotator cuff tear, but poor agreement in predicting the grade of a partial-thickness tear.
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Affiliation(s)
- Edwin E Spencer
- Shoulder and Elbow Institute, Knoxville Orthopaedic Clinic, Knoxville, TN 37922, USA.
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Zilber S, Carillon Y, Lapner PC, Walch G, Nové-Josserand L. Infraspinatus delamination does not affect supraspinatus tear repair. Clin Orthop Relat Res 2007; 458:63-9. [PMID: 17308479 DOI: 10.1097/blo.0b013e31803b8da7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Supraspinatus full-thickness tears with associated infraspinatus delamination are a frequent lesion, although the results of repair have not been reported. We retrospectively identified 35 patients treated for this cuff lesion among 378 open repaired full-thickness cuff tears. The aim of the study was to assess the subjective, objective, and anatomic outcomes of a subset of patients with supraspinatus tears involving delamination of the whole infraspinatus tendon. Thirty of the 35 patients were reviewed with magnetic resonance imaging at a minimum followup of 2 years (mean, 3.5 years; range, 2-6.5 years). The mean nonweighted Constant-Murley score at followup was 80/100 points, with an average gain of 17 points. Magnetic resonance imaging revealed all supraspinatus tendons but two were continuous. We observed no tear of the infraspinatus tendon, although a persistent delamination was present in 11 cases. One half of the patients had minor weakness in external rotation. One third of the infraspinatus muscles had minor fatty infiltration. Conservation of the infraspinatus tendon after closing the delamination did not seem to compromise the outcome of the supraspinatus repair. Avoiding resection of the infraspinatus delamination and treatment with simple curettage and closure yields satisfactory midterm functional and anatomic results.
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Affiliation(s)
- Sébastien Zilber
- Orthopedics and Bone Trauma Department, Henri Mondor Teaching Hospital, Fréteil, France
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Stecco A, Brambilla M, Puppi AMA, Lovisolo M, Boldorini R, Carriero A. Shoulder MR arthrography: In vitro determination of optimal gadolinium dilution as a function of field strength. J Magn Reson Imaging 2007; 25:200-7. [PMID: 17152058 DOI: 10.1002/jmri.20788] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To find the optimal contrast agent dilution to maximize signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in shoulder MR arthrography using MR systems operating at different magnetic field strengths. MATERIALS AND METHODS Autoptic human glenohumeral ligaments were inserted in eight egg-shaped 20-mL phantoms filled with saline and gadolinium diethylenetriaminepentaacetic acid bismethylamide (Gd-DTPA-BMA) in different dilutions of 0.5, 1, 2, 2.5, 5, 12.5, 50 mmol/liter, to simulate the shoulder articular capsule. These phantoms were inserted inside two plastic 240-mL phantoms filled with water. MRI was performed on 0.2-, 0.5-, 1.0-, 1.5-, and 3.0-T MR systems using a three-dimensional gradient echo (GRE)-T1-weighted pulse sequence. SI, SNR, and CNR were determined. RESULTS Peak SI and SNR were found at 5 mmol/liter, with the exception of the 0.2-T scanner, where the maximum was at 2 mmol/liter. Peak CNR was observed at 1 mmol/liter for the 3-T scanner, at 2 mmol/liter for the 0.2- and 0.5-T scanners, and at 5 mmol/liter for the remaining scanners. CONCLUSION The optimal SI and SNR are provided by 5 mmol/liter contrast agent dilution. Peak CNR was found in a range between 1 and 5 mmol/liter dilutions, depending on the strength of the magnetic field.
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Affiliation(s)
- Alessandro Stecco
- Radiology Department, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy.
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Farber A, Fayad L, Johnson T, Cascio B, Shindle M, Neubauer P, Khanna AJ. Magnetic resonance imaging of the shoulder. Current techniques and spectrum of disease. J Bone Joint Surg Am 2006; 88 Suppl 4:64-79. [PMID: 17142436 DOI: 10.2106/jbjs.f.00583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Adam Farber
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 North Caroline Street, JHOC 5th Floor, Baltimore, MD 21287-0883, USA.
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Abstract
MR imaging is the optimal method for evaluating suspected rotator cuff pathology. Current techniques of fast spin-echo imaging without and with fat suppression allow accurate identification and characterization of tendinous and myotendinous abnormalities of the rotator cuff. Impingement disorders, tendon degeneration, instability,and trauma comprise the multifactorial nature of rotator cuff disease. This article addresses the role of MR imaging in evaluating the rotator cuff and the importance of MR imaging in identifying other lesions that may mimic rotator cuff pathology. A rationale for protocol design, including MR arthrography and the use of specialized positioning, such as abduction and external rotation (ABER), are discussed.
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Affiliation(s)
- Ara Kassarjian
- Musculoskeletal MRI, Massachusetts General Hospital, 15 Parkman Street, Suite 515, Boston, MA 02114, USA.
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Herold T, Bachthaler M, Hamer OW, Hente R, Feuerbach S, Fellner C, Strotzer M, Lenhart M, Paetzel C. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Radiology 2006; 240:152-60. [PMID: 16709790 DOI: 10.1148/radiol.2393050453] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate prospectively the accuracy of indirect magnetic resonance (MR) arthrography for supraspinatus tendon tears during neutral positioning or abduction and external rotation (ABER) and neutral positioning. MATERIALS AND METHODS Informed consent was obtained in all patients, and the study was approved by the institutional review board. Indirect MR arthrography of the shoulder was performed in 51 symptomatic patients (14 female, 37 male; mean age, 47 years) in the neutral position (set 1) and in the neutral and ABER positions (set 2). Two readers independently interpreted both sets, and diagnoses were compared with arthroscopic findings. Diagnostic accuracy was calculated, and 95% confidence intervals were used to detect significant differences between sets. Diagnostic confidence was recorded by using a three-level confidence score. Differences between sets were evaluated by using the Wilcoxon signed rank test. Interobserver agreement was determined separately for each set and for all diagnoses, full-thickness tears, and partial-thickness tears. RESULTS For full-thickness tears, there was no benefit to reading set 2. For reader 1, sensitivity and specificity were 95% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 80% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For partial-thickness tears, sensitivity was significantly higher after reading set 2. For reader 1, sensitivity and specificity were 71% and 88%, respectively, for set 1 and 93% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 50% and 88%, respectively, for set 1 and 86% and 94%, respectively, for set 2. For both readers, diagnostic confidence for partial-thickness tears was significantly higher after reading set 2. After the interpretation of set 2, kappa values increased from 0.35 to 1.00 for full-thickness tears and from 0.12 to 0.63 for partial-thickness tears. CONCLUSION Indirect MR arthrography with supplementary images obtained with patients in the ABER position significantly improved sensitivity and increased diagnostic confidence for partial-thickness tears of the supraspinatus tendon. Interobserver agreement was improved for both full- and partial-thickness tears.
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Affiliation(s)
- Thomas Herold
- Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.
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Ramnath RR. 3T MR Imaging of the Musculoskeletal System (Part II): Clinical Applications. Magn Reson Imaging Clin N Am 2006; 14:41-62. [PMID: 16530634 DOI: 10.1016/j.mric.2006.01.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The gain in SNR that is afforded by 3T MR imaging systems has tremendous clinical applications in the musculoskeletal system. The potential for demonstrating and enhancing the visibility of normal osseous, tendinous, cartilaginous, and ligamentous structures is exciting. Furthermore, harnessing this added signal to increase spatial resolution may improve our diagnostic abilities in various joints dramatically. Radiologists have enjoyed great success in assessing joint disease with current MR imaging field strengths; however, many intrinsic joint structures remain poorly evaluated, which leads to a golden opportunity for 3T MR imaging. The articular cartilage of the knee, the glenoid labrum of the shoulder, the intrinsic ligaments and TFC of the wrist, the collateral ligaments of the elbow, the labrum and articular cartilage of the hip, and the collateral ligaments of the ankle have been evaluated suboptimally on 1 .5T systems using routine nonarthrographic MR images. Because of the enhanced SNR, the higher spatial resolution, and the greater CNR of intrinsic joint structures at higher field strengths, 3T MR imaging has the potential to improve diagnostic abilities in the musculoskeletal system vastly, which translates into better patient care and management. The author's 2 years of clinical experience with musculoskeletal MR imaging on 3T systems has met and exceeded his expectations, and has bolstered the confidence of his orthopedic surgeons in his diagnoses. As coil technology advances and as the use of parallel imaging becomes more available in the extremities, the author expects to see even more dramatic improvements in image quality.
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Stetson WB, Phillips T, Deutsch A. The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. J Bone Joint Surg Am 2005; 87 Suppl 2:81-8. [PMID: 16326727 DOI: 10.2106/jbjs.e.00509] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William B Stetson
- Dept. of Orthopedic Surgery, University of Southern California, 201 South Buena Vista Street, Burbank, CA 91505, USA.
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Kijowski R, Farber JM, Medina J, Morrison W, Ying J, Buckwalter K. Comparison of fat-suppressed T2-weighted fast spin-echo sequence and modified STIR sequence in the evaluation of the rotator cuff tendon. AJR Am J Roentgenol 2005; 185:371-8. [PMID: 16037507 DOI: 10.2214/ajr.185.2.01850371] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was performed to determine whether a modified version of the classic STIR sequence provides similar information about the integrity of the rotator cuff tendon as the commonly used fat-suppressed T2-weighted fast spin-echo sequence. SUBJECTS AND METHODS Sixty-one consecutive MRI examinations of the shoulder in 57 patients were performed using a coronal oblique T1-weighted spin-echo sequence, a modified version of the STIR sequence, and a fat-suppressed T2-weighted fast spin-echo sequence. Three reviewers independently assessed the rotator cuff tendon using the coronal oblique modified inversion recovery sequence and T1-weighted spin-echo sequence. After a minimum of 4 weeks, reviewers assessed the rotator cuff tendon using the fat-suppressed T2-weighted fast spin-echo sequence and T1-weighted spin-echo sequence. The kappa statistic was used to measure the degree of concordance between interpretations when each sequence was used independently. The conditional probability that a full- and a partial-thickness tear would be diagnosed on both sequences was calculated. Image quality was assessed in a side-by-side comparison. RESULTS The overall weighted kappa score was 0.82, which indicates excellent concordance between the two sequences. If a full-thickness tear of the rotator cuff tendon was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was a 94.1% probability that the same conclusion would be reached using the modified inversion recovery sequence. If a partial-thickness tear was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was an 80.3% probability that the same conclusion would be reached with the modified inversion recovery sequence. Fat suppression in the modified inversion recovery sequence was superior to that in the T2-weighted fast spin-echo sequence in 26-39% of the examinations. CONCLUSION The modified inversion recovery sequence and fat-suppressed T2-weighted fast spin-echo sequence provide similar information about the integrity of the rotator cuff tendon.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, Indiana University Medical Center, Indianapolis, IN 46202-5253, USA
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Toyoda H, Ito Y, Tomo H, Nakao Y, Koike T, Takaoka K. Evaluation of rotator cuff tears with magnetic resonance arthrography. Clin Orthop Relat Res 2005; 439:109-15. [PMID: 16205148 DOI: 10.1097/01.blo.0000176142.01262.35] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The size and morphologic features of rotator cuff tears may influence treatment selection and affect final outcomes. Magnetic resonance arthrography allows observation of these features and other intraarticular structures. To assess the utility of magnetic resonance imaging in assessing size and morphologic features, we retrospectively reviewed observations on 41 shoulders in 37 consecutive surgically treated patients (mean age, 63.2 years) who had magnetic resonance imaging followed by magnetic resonance arthrography. The maximum rotator cuff defect size in the anteroposterior direction defined transverse size, and the maximum rotator cuff defect size in the mediolateral direction defined longitudinal size. Sensitivities for detecting full-thickness rotator cuff tears by magnetic resonance imaging and magnetic resonance arthrography were 90.2% and 100%, respectively. Maximum longitudinal and transverse dimensions of the tear as shown by magnetic resonance arthrography correlated better with intraoperative measurements (r2 = 0.85 transversely, 0.92 longitudinally) than magnetic resonance imaging measurements (r2 = 0.47 transversely, 0.26 longitudinally). The reproducibility of the two methods is similar. Magnetic resonance arthrography also allowed morphologic classification of the torn tendon as blunt end, tapering end, indistinct end, horizontal tear, and global tear. There was good agreement in classifying torn edges; the imaging findings agreed with findings at surgery. Magnetic resonance arthrography was more accurate in evaluating rotator cuff tear size and morphologic features than conventional magnetic resonance imaging.
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Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
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Fermand M, Sihassen C, Mauget D, Sarazin L, Chevrot A, Drapé JL. Ruptures hyperéchogènes de la coiffe des rotateurs. ACTA ACUST UNITED AC 2005; 86:159-63. [PMID: 15798625 DOI: 10.1016/s0221-0363(05)81336-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To describe unusual rotator cuff tendon tears which are hyperechoic at ultrasonography (US). MATERIALS AND METHOD We retrospectively reviewed the shoulder US examinations of 100 patients with rotator cuff tear demonstrated by CT arthrogram with bursography. We included in this study hyperechoic foci without surrounding hypoechoic zone. A second US examination was performed after bursal distension. RESULTS Six (6%) hyperechoic foci were detected. The initial US diagnosis was tendinosis in five cases (n=5) and full thickness tear in one case (n=1). At repeat US examination, the hyperechoic area was completely or partially hypoechoic, probably because the tears were filled with the injected hypoechoic fluid. CONCLUSION Some rotator cuff tears, filled with fibrinoid fragments, are probably underdiagnosed at US.
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Affiliation(s)
- M Fermand
- Service de Radiologie B, CHU Cochin, 27 rue du Fg St-Jacques, 27 rue du faubourg Saint-Jacques, 75014 Paris
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Stetson WB, Ryu RK, Bittar ES. Arthroscopic treatment of partial rotator cuff tears. OPER TECHN SPORT MED 2004. [DOI: 10.1053/j.otsm.2004.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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TEEFEY SHARLENEA, RUBIN DAVIDA, MIDDLETON WILLIAMD, HILDEBOLT CHARLESF, LEIBOLD ROBERTA, YAMAGUCHI KEN. DETECTION AND QUANTIFICATION OF ROTATOR CUFF TEARS. J Bone Joint Surg Am 2004. [DOI: 10.2106/00004623-200404000-00007] [Citation(s) in RCA: 408] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Affiliation(s)
- Ara Kassarjian
- Musculoskeletal MRI, Massachusetts General Hospital, 15 Parkman Street, Suite 515, Boston, MA 02114, USA.
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Zlatkin MB, Hoffman C, Shellock FG. Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi-center study. J Magn Reson Imaging 2004; 19:623-31. [PMID: 15112313 DOI: 10.1002/jmri.20040] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To conduct a multi-center assessment of the use of a 0.2-T, extremity MR system (E-scan; General Electric Lunar Corp. and Esaote, Genoa, Italy) for identifying tears of the rotator cuff and glenoid labrum. MATERIALS AND METHODS A retrospective study was performed involving 160 patients (age range, 15-84 years old) from five facilities in the United States, comparing shoulder MR imaging to surgical findings. MR imaging of the shoulder was conducted as follows: shoulder coil; T1-weighted spin echo, coronal-oblique and axial images; short Tau inversion recovery (STIR), coronal-oblique images and axial images; and T2-weighted spin echo, coronal-oblique and sagittal-oblique images. The MR examinations were interpreted in an independent, prospective manner by two radiologists with extensive musculoskeletal MRI experience. Arthroscopic (N = 103) or open surgical (N = 57) procedures were performed within a mean of 53 days after MR imaging. RESULTS Surgical findings demonstrated rotator cuff tears in 131 patients and labral tears in 60 patients. For the rotator cuff, the sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 93%, 98%, and 68%, respectively. For the labrum, the sensitivity, specificity, positive predictive value, and negative predictive value were 55%, 100%, 100%, and 82%, respectively. CONCLUSIONS There was good agreement when MR results obtained using the extremity MR system were compared to surgical findings for identifying rotator cuff tears, while the sensitivity of MR imaging for determining labral tears was relatively poor. Nevertheless, these findings were comparable to those reported in the peer-reviewed literature for MR systems operating at mid-, and high-field-strengths.
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Abstract
Impingement pain and rotator cuff injury are common in athletes, particularly in overhead throwers. The cuff can be injured in these patients in the typical location in the anterior supraspinatus tendon and near the junction of the supraspinatus and infraspinatus tendons. The cuff tears in athletes are usually small, articular surface partial-thickness tears. The posterior cuff tears in overhead throwers are seen best at MR arthrography with the arm in abduction and external rotation. Other abnormalities, such as instability lesions or labral fraying, can be associated with rotator cuff tears in athletes.
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Affiliation(s)
- Michael J Tuite
- Department of Radiology, University of Wisconsin Hospital and Clinics, Clinical Science Center-E3/311, 600 Highland Avenue, Madison, WI 53792-3252, USA.
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Abstract
Magnetic resonance imaging has proven to be useful in the assessment of rotator cuff injuries. Improvements in magnetic resonance techniques, including fast spin-echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff. Rotator cuff disease is multifactorial. Primary impingement within the coracoacromial arch, degeneration of the rotator cuff tendons, trauma, and glenohumeral instability may be contributing factors. Shoulder pain in athletes can be related to acute myotendinous and muscle injuries, which can be easily detected using magnetic resonance imaging.
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Affiliation(s)
- Jenny T Bencardino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Wu HP, Dubinsky TJ, Richardson ML. Association of shoulder sonographic findings with subsequent surgical treatment for rotator cuff injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:155-161. [PMID: 12562120 DOI: 10.7863/jum.2003.22.2.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To identify any clinical and radiologic findings of rotator cuff injury that predict whether patients will undergo shoulder surgery. METHODS We retrospectively studied all shoulder sonograms obtained at a single institution over 12 months. Possible predictors of surgical treatment were documented, including patient age and sex, duration and types of symptoms, and the location and severity of tendon damage on sonography. One hundred twenty-eight patients underwent shoulder sonography; 34 patients eventually underwent shoulder surgery. Multivariate logistic regression was performed to identify clinical and sonographic factors associated with the use of surgical therapy. RESULTS The only statistically significant predictor of surgical intervention was the finding of full-thickness tears (with or without tendon retraction) on sonography (P = .03). Patients with full-thickness tears were 4.3 times more likely to undergo surgery than those with no tears (odds ratio, 4.3). CONCLUSIONS The sonographic diagnosis of full-thickness rotator cuff tears is the only finding statistically associated with the use of surgical treatment. No single clinical variable was consistently associated with subsequent surgery. Partial-thickness tears on sonography also do not show any statistical association with the eventual use of surgery for rotator cuff symptoms.
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Affiliation(s)
- Herman P Wu
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA
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Li T, Mirowitz SA. Comparative study of fast MR imaging: quantitative analysis on image quality and efficiency among various time frames and contrast behaviors. Magn Reson Imaging 2002; 20:471-8. [PMID: 12361794 DOI: 10.1016/s0730-725x(02)00527-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to quantitatively compare the image quality and efficiency provided by widely available fast MR imaging pulse sequences. A composite phantom with various T1 and T2 values and subjected to periodic motion was imaged at 1.5 T. The fast MRI sequences evaluated included fast spin-echo (FSE), single shot fast spin-echo (SSFSE), echo-planar imaging (EPI), multi-slice gradient recalled (MPGR), fast MPGR (FMPGR), and fast multi-slice spoiled gradient echo (FMPSPGR). T1-weighted (T1WI), T2-weighted (T2WI), proton-density-weighted (PDWI), and T2*-weighted (T2*WI) images were evaluated in breath-hold and non-breath-hold time frames. Analysis included measurement of image signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), nonuniformity, ghosting ratio, SNR per unit time and CNR per unit time. Among fast T2WI sequences, FSE with breath-hold time frame resulted in the highest image quality and in superior SNR and CNR efficiency by a factor of 5 or 6 as compared with conventional spin echo sequence. Among fast T1WI sequences, FMPGR and FMPSPGR both with non-breath-hold time frame produced the highest image quality and SNR and CNR efficiency by a factor of greater than 5 as compared with conventional spin echo. Among fast PDWI and T2*WI sequences, FSE produced the highest SNR and CNR, and was maximally efficient with a factors of greater than 6 as compared with conventional spin echo.
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Affiliation(s)
- Tao Li
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213-2582, USA.
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