Quantitative MRI indicators and features for partial subscapularis tendon tears on conventional shoulder MRI

Abstract

Background Diagnosing partial subscapularis (SSC) tendon tears still faces challenges. A failure rate of massive posterosuperior rotator cuff tear repair will be highly increased when extending more than one-third of SSC tendon. This study aims to investigate the quantitative indicators and features of partial SSC tears on conventional shoulder MRI and improve the preoperative diagnostic accuracy. Materials and methods Four hundred and thirty-seven patients underwent MRI and arthroscopy were retrospectively reviewed; 89 patients with partial SSC tears in case group and 50 patients with normal SSC in control group were included. Six MRI features with the explicit definition of some quantitative indicators were evaluated. Results Fissure sign showed the highest diagnostic efficiency for the partial SSC tears, with a specificity of 92%, sensitivity of 75.3%, and accuracy of 81.3%. Thinning of SSC, fluid collection under the coraco-glenoid arch (CGA), and combined SSP complete tear also showed high specificity of 86%, 80%, and 80%, respectively, while the sensitivity and accuracy were moderate, with a sensitivity of 38.2%, 50.6%, and 48.3%, respectively, an accuracy of 55.4%, 61.2%, and 59.7%, respectively. The specificity, sensitivity, and accuracy of lesser tuberosity cysts were all moderate with values of 68%, 56.2%, and 60%, respectively. However, fat accumulation under the CGA showed no significant difference between the partial SSC tears group and the control group. Conclusion Several specific MRI features with quantitative indicators defined in this study can be used to improve the accuracy of preoperative MRI diagnosis of partial SSC tears.

Evaluation of Preoperative Magnetic Resonance Imaging Parameters with Arthroscopic Validation of Subscapularis Tendon Abnormalities in 187 Patients at a Single Center in Turkey

“…Wang et al compared patients with and without partial SS rupture with different MRI parameters than in the present study [22], reporting that the fissure sign showed the highest diagnostic efficiency for partial SS tears (92% specificity, 75.3% sensitivity, and 81.3% accuracy). In the present study, coraco-humeral distance, coracoid overlap, coraco-humeral angle, lesser tuberosity angle, and coracoid angle measurements correctly identified SS ruptures before surgery.…”

“…Although many studies have been conducted to strengthen the diagnosis of SS tendon ruptures, the false negativity of imaging methods should not be ignored. Few studies have performed MRI evaluation in cases of arthroscopically proven SS tendon rupture [18,22]. We made all measurements considering that the accuracy would increase with the use of retrospective MRI scans of arthroscopically proven cases.…”

Subscapularis tendon tears: A narrative review

“…Long Head of the Biceps (LHB) tendon subluxation, subscapularis muscle belly atrophy in the sagittal plane, torn subscapularis fibers and bare lesser tuberosity are important findings in subscapular tendon ruptures (11). Bone marrow edema, cysts, and fat atrophy in the tuberculum minor are the symptoms of chronic tears (30). In addition, although no subscapular tear is seen in the MRI findings of patients whose surgery is planned due to rotator cuff tear, the presence of subcoracoid effusion should bring to mind intraoperative subscapular evaluation (31).…”