Reliability of Bigliani's Classification using Magnetic Resonance Imaging for Determination of Acromial Morphology

Automatic measurement of X-ray radiographic parameters based on cascaded HRNet model from the supraspinatus outlet radiographs

Background

Rotator cuff injury is a common cause of shoulder pain. Precise and efficient measurement of morphological parameters is necessary in the clinical diagnosis and evaluation of shoulder disorders. However, manual measurement is a time-consuming and labor-intensive task, with low inter-observer reliability. The automatic measurement of radiographic parameters in supraspinatus outlet radiographs has not been reported yet. Thus, the objective of this study was to use a cascaded High-Resolution Net (HRNet) model based on deep learning (DL) algorithms to automatically measure morphological parameters from supraspinatus outlet radiographs and assess its performance. It was intended for use in early screening of patients with rotator cuff disease and to guide them to further consultation.

Methods

This cross-sectional study collected 1,668 supraspinatus outlet radiographs from the picture archiving and communication system of Gansu Provincial Hospital of Traditional Chinese Medicine and the Affiliated Hospital of Gansu University of Chinese Medicine. Among them, 521 images were provided for test datasets and 1,147 images were provided for a model training dataset and validation dataset. Landmarks were annotated for acromio-humeral interval (AHI), acromial tilt (AT), and 3 lines in Park's acromial classification (line huo-acrf, line acro-acro1, and line huo-acro1). R4 radiologist reviewed the means of 3 radiologists as a reference standard. Model performance was assessed by calculating the percentage of correct key points (PCK), intra-class correlation coefficients (ICCs), Pearson's correlation coefficients, mean absolute error, and root mean square error. The reliability of R1, R2, R3, AI with R4 and inter-observer reliability of R1, R2, and R3 for acromial morphology classification were assessed by Cohen's kappa coefficient.

Results

Within the 3-mm threshold, the PCK of the model ranged from 74% to 100%. Compared to the reference standard, the model had reliable measurement of AHI, AT, line huo-acrf, line acro-acro1, line huo-acro1 (ICC =0.73-0.94) and moderate reliability of acromial morphology classification (k=0.50-0.56).

Conclusions

The cascaded HRNet developed in this study can automatically measure morphological parameters of the shoulder. It may aid early clinical screening for shoulder disorders and assist physicians in treatment decisions.

Rotator Cuff Repair With or Without Acromioplasty: A Systematic Review of Randomized Controlled Trials With Outcomes Based on Acromial Type

BACKGROUND

It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type.

PURPOSE

To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type.

STUDY DESIGN

Systematic review; Level of evidence, 2.

METHODS

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs).

RESULTS

Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P = .031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group.

CONCLUSION

There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data.

[Pathologies of the shoulder joint : Anatomy and examination techniques]

CLINICAL ISSUE

The movements and stability of the human shoulder are a complex dynamic interaction between several joints, muscles and ligaments, which on the one hand enable extensive mobility and on the other hand must provide the necessary stability. Furthermore, the complexity of the shoulder is increased by a large number of normal variants. This article aims to explain the relevant anatomical structures and the radiological examination techniques necessary to visualize them.

STANDARD RADIOLOGICAL PROCEDURES

Various modalities contribute to the examination of the shoulder. These include X‑rays, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

METHODOLOGICAL INNOVATION

It is important to use the various procedures appropriately. Especially with MRI arthrography, it is necessary to pay attention to suitable sequences and possibly additional examination positions.

PRACTICAL RECOMMENDATION

The multimodal examination of the shoulder can contribute to the diagnosis of numerous clinical pictures. Anatomical and methodological foundations are essential for this.