Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair

Abstract

Purpose To evaluate the diagnostic accuracy between magnetic resonance arthrography (MRA) and arthroscopic examination for the assessment of pathologies of the long head of the biceps (LHB) prior to rotator cuf (RC) repair. The hypothesis was that MRA is suitable to identify biceps instabilities, due to improved visibility of the biceps pulley. Methods Sixty-six patients aged 58.5 ± 17.6 (range, 46-71) scheduled to have RC repair between 2016 and 2017 were prospectively enrolled. MRA images of the LHB were interpreted by one radiologist and two surgeons, then compared to arthroscopic indings. The sensitivity, speciicity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by comparing MRA axial readings to arthroscopic assessment in the neutral position (static instability), MRA sagittal readings to arthroscopic assessment in external rotation (dynamic s instability), MRA coronal and axial readings to arthroscopic assessment in the neutral position (tendinopathy). Results Among the three observers, the radiologist obtained the highest sensitivity and speciicity for MRA, which were respectively: ( 1) for static instability, 62% (C.I. 35-85) and 77% (C.I. 63-88); (2) for dynamic instability, 50% (C.I. 29-71) and 62% (C.I. 46-77), and (3) for tendinopathy, 49% (C.I. 36-62) and 100% (C.I. 3-100). Conclusions MRA is not suitable for the diagnosis of LHB lesions prior to arthroscopic rotator cuf repair. Level of evidence Diagnostic study, Level I. Keywords Magnetic resonance arthrography • Arthroscopic rotator cuf repair • Lesion of the long head of the biceps • Diagnostic accuracy

3D imaging has good specificity but poor sensitivity for the diagnosis of pathologies of the long head of the biceps: a systematic review and meta-analysis

“…A total of 1480 studies were excluded by examining their titles and/or abstracts, and a further 28 studies were excluded after full‐text review [3, 5, 7, 8, 10, 14, 16, 18, 20, 21, 27, 28, 32, 36, 38, 39, 41, 45, 46, 49, 51, 53, 54]. This left 15 eligible studies [4, 6, 8, 9, 11–13, 17, 19, 22, 26, 30, 31, 33–35, 40, 43, 44, 47, 48] that reported on a total of 2734 patients (Tables 1, 2). Nine studies were eligible for meta‐analysis [6, 13, 19, 31, 34, 40, 43, 48] (Fig.…”

“…This left 15 eligible studies [4, 6, 8, 9, 11–13, 17, 19, 22, 26, 30, 31, 33–35, 40, 43, 44, 47, 48] that reported on a total of 2734 patients (Tables 1, 2). Nine studies were eligible for meta‐analysis [6, 13, 19, 31, 34, 40, 43, 48] (Fig. 1).…”

“…Twelve studies (16 datasets) reported the diagnostic accuracy to detect LHBT instability [6, 12, 30, 31, 34, 35, 43, 48]; six studies (11 datasets) used MRI [6, 12, 31, 35, 43, 48], two studies (four datasets) used magnetic resonance arthrography (MRA) [30, 34], and one study (one dataset) used CTA [13]. The ranges of sensitivity and specificity reported for MRI were 0.31–1.00 and 0.53–1.00, respectively, while those reported for MRA were 0.34–0.78 and 0.73–0.79, respectively.…”

The long head of biceps at the shoulder: a scoping review

“…There was an overall trend for low sensitivity and high diagnostic accuracy and specificity values for the exclusion and detection of full thickness and complete tears of the LHBT for both MRI and MRA, respectively, compared with low specificity and sensitivity values to rule in and out partial thickness tears of the LHBT [ 60 , 90 , 118 , 139 , 150 , 155 , 180 , 188 ]. LHBT instability demonstrated variable specificity, and sensitivity values with a trend for higher specificity values to rule in dislocation of the LHBT compared with subluxation, whilst the sensitivity values in many of the studies identifying LHBT instability were poor [ 60 , 90 , 118 , 134 , 139 , 150 , 155 , 165 , 180 , 188 ]. In a single systematic comparison of MRI and MRA, MRA demonstrated higher specificity for detecting LHBT appearance and position than MRI [ 221 ].…”

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

“…A variety of diagnostic imaging technologies provide accurate information for rotator cuff surgery. These clinical examination methods include radiographs, magnetic resonance imaging (MRI; Burks et al, 2009;Loock et al, 2019;Kim et al, 2020;Liu et al, 2020), computed tomography (CT; Asmar et al, 2020), and ultrasound (US). X-ray as conventional radiography can be used as the initial diagnostic method for rotator cuff disease.…”