MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy

Abstract

Introduction: Rotator cuff tears are quite common and can cause significant disability. Magnetic Resonance Imaging (MRI) has now emerged as the modality of choice in the preoperative evaluation of patients with rotator cuff injuries, in view of its improved inherent soft tissue contrast and resolution. Aim:To evaluate the diagnostic accuracy of routine MRI in the detection and characterisation of rotator cuff tears, by correlating the findings with arthroscopy. Materials and Methods:This prospective study was carried out between July 2014 and August 2016 at the AJ Institute of Medical Sciences, Mangalore, Karnataka, India. A total of 82 patients were diagnosed with rotator cuff injury on MRI during this period, out of which 45 patients who underwent further evaluation with arthroscopy were included in this study. The data collected was analysed for significant correlation between MRI diagnosis and arthroscopic findings using kappa statistics. The sensitivity, specificity, predictive value and accuracy of MRI for the diagnosis of full and partial thickness tears were calculated using arthroscopic findings as the reference standard.Results: There were 27 males and 18 females in this study.The youngest patient was 22 years and the oldest was 74 years. Majority of rotator cuff tears (78%) were seen in patients above the age of 40 years. MRI showed a sensitivity of 89.6%, specificity of 100%, positive predictive value of 100% and negative predictive value of 83.3% for the diagnosis of full thickness rotator cuff tears. For partial thickness tears, MRI showed a sensitivity of 100%, specificity of 86.6%, positive predictive value of 78.9% and negative predictive value of 100%. The accuracy was 93.1% for full thickness tears and 91.1% for partial thickness tears. The p-value was less than 0.01 for both full and partial thickness tears. There was good agreement between the MRI and arthroscopic findings, with kappa value of 0.85 for full thickness tears and 0.81 for partial thickness tears. Conclusion:MRI revealed high sensitivity and specificity for the diagnosis of rotator cuff tears with accuracy of 93.1% for full thickness tears and 91.1% for partial thickness tears. MRI provides useful information about the size and extent of the tear, involvement of adjacent structures, presence of muscle atrophy and tendon retraction, all of which have important therapeutic and prognostic implications.

Do subscapularis tears really result in superior humeral migration?

“…A focal discontinuity in the supraspinatus tendon extending from the articular to the bursal surface was assumed to be a full thickness rotator cuff tear on coronal oblique images and appears as fluid signal intensity on T2W. 10 An increased intermediate or fluid-like signal within the substance of the tendon, tendon margin irregularity, defect within the tendon, and/or retraction of the tendon were the criteria of subscapularis tear. 11 The involvement of the signal change within the substance of the tendon determined the size of the tear as full-thickness (tear extending from the articular surface to the bursal surface) or partial tear (only a portion of the tendon).…”

Recent MRI Study of Acute Shoulder Trauma

“…Amongst patients with shoulder pain, rotator cuff disorders are most frequently implicated, being present in up to 86% of patients [7] . The incidence of traumatic rotator cuff tears is unknown, but it is thought to be relatively uncommon in younger athletes.…”

7-T clinical MRI of the shoulder in patients with suspected lesions of the rotator cuff

“…Magnetic resonance imaging (MRI) is the most comprehensive imaging method to visualise soft tissue pathologies of the shoulder [1,2]. As a standard of care procedure, it is widely used at field strengths of 1.5 or 3 T and has proven high diagnostic accuracy in the diagnosis of rotator cuff tears [3]. Room for improvement exists in subtler abnormalities [4] like low grade cartilage lesions, where a reduced accuracy at both 1.5 and 3 T has been shown [5], or the classification of superior glenoid labrum anterior to posterior (SLAP) lesions [6].…”