Threshold-based quantification of fatty degeneration in the supraspinatus muscle on MRI as an alternative method to Goutallier classification and single-voxel MR spectroscopy

Lee, Dokwan; Hong, Ki Taek; Lee, Wonhee; Khil, Eun Kyung; Lee, Guen Young; Choi, Jung Ah; Song, Yongnam

doi:10.1186/s12891-020-03400-4

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…Fatty infiltration in the RC muscles is highly related to the retear rate and shoulder function postoperatively, which was evaluated several decades ago in clinical settings. 32,33,47,48 With advances in imaging techniques, intramuscular FF can be fully captured through 3D models, with theoretically high reliability and strong objectivity. 54 Several studies recently compared 2D-FF from traditional single sagittal slices and 3D-FF measured by modified 3D methods to determine their differences in clinical scenarios; however, the conclusions were inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Advantages of 3–dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice

Liu

Jin

et al. 2022

Am J Sports Med

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Background: Fatty infiltration of the rotator cuff muscles is highly related to poor outcomes after rotator cuff tears. Fat fraction (FF) based on traditional 2–dimensional measurements (2D-FF) from a single sagittal Y-view slice cannot determine intramuscular FF in the rotator cuff muscles; the newly developed 3–dimensional method (3D-FF) is supposed to precede 2D measurements for intramuscular FF evaluation in accuracy and reliability. Purpose: (1) To measure 3D-FF and (2) to compare 3D-FF and 2D-FF in terms of quantitative values and intra- and interobserver agreement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Six-point Dixon magnetic resonance imaging was performed in patients with full–thickness supraspinatus tears. 2D-FF was calculated on a single sagittal Y-view. Semiautomatic segmentation software (ITK-SNAP) was used to reconstruct 3D volumes of the supraspinatus muscle and fat. 3D-FF was obtained by dividing the fat volume by the total volume of the supraspinatus muscle. A paired t test was used to compare the individual differences between 2D-FF and 3D-FF results. Linear regression and Bland-Altman analyses were performed to determine the agreement between 2D-FF and 3D-FF. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver agreement. Results: The 3D muscular and fatty models presented an inhomogeneous distribution of intramuscular fat in the supraspinatus, indicating the superiority of 3D-FF over 2D-FF in capturing all muscle morphologic information. 2D-FF was significantly higher than 3D-FF in the supraspinatus with large (19.5% ± 5.9% vs 16.2% ± 3.7%; P = .002) and massive (34.8% ± 13.3% vs 26.2% ± 9.4%; P < .001) rotator cuff tears. 2D-FF overestimated the FF compared with 3D-FF by >50% in 14.7% of all patients and by >15% in 67.6% of patients with large or massive RCTs. The discrepancy between 2D-FF and 3D-FF increased with increasing mean FF. The intra- and interobserver agreement of 3D-FF (ICCs, 0.89-0.99 and 0.89-0.95) was superior to that of 2D-FF (ICCs, 0.71-0.95 and 0.64-0.79). Conclusion: 3D-FF indicated an inhomogeneous distribution of intramuscular fat by capturing all muscle and fat morphologic information. In patients with large and massive rotator cuff tears, 2D-FF of the supraspinatus was significantly higher than 3D-FF. 3D-FF was more reliable than 2D-FF for estimating fatty infiltration in the supraspinatus, with better intra- and interobserver agreement.

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Section: Discussionmentioning

confidence: 99%

Advantages of 3–dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice

Liu

Jin

et al. 2022

Am J Sports Med

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“…Atrophic changes and fatty infiltration of the rotator-cuff musculature are two of the more commonly accepted findings associated with large tears, and several methods for quantifying these changes have been described 12 , 14 , 15 . The scapular Y-view of the MRI, the lateral-most T1 sagittal MR image in which the scapular spine and body are in contact, is the base image for obtaining reliable indicators of the supraspinatus muscle status (for example, occupation ratio, tangent sign, and fatty infiltration) 14 , 16 , 17 .…”

Section: Discussionmentioning

confidence: 99%

“…If the intensity distribution in the image is clear, a more accurate classification is possible. Therefore, Otsu thresholding is expected to easily detect a threshold value at the pixel intensity, which maximizes the differences between the foreground (bright) and background (dark) pixels 15 .…”

Section: Methodsmentioning

confidence: 99%

Deep-learning framework and computer assisted fatty infiltration analysis for the supraspinatus muscle in MRI

Ro¹,

Kim

Park

et al. 2021

Sci Rep

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Occupation ratio and fatty infiltration are important parameters for evaluating patients with rotator cuff tears. We analyzed the occupation ratio using a deep-learning framework and studied the fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. To calculate the amount of fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. The mean Dice similarity coefficient, accuracy, sensitivity, specificity, and relative area difference for the segmented lesion, measuring the similarity of clinician assessment and that of a deep neural network, were 0.97, 99.84, 96.89, 99.92, and 0.07, respectively, for the supraspinatus fossa and 0.94, 99.89, 93.34, 99.95, and 2.03, respectively, for the supraspinatus muscle. The fatty infiltration measure using the Otsu thresholding method significantly differed among the Goutallier grades (Grade 0; 0.06, Grade 1; 4.68, Grade 2; 20.10, Grade 3; 42.86, Grade 4; 55.79, p < 0.0001). The occupation ratio and fatty infiltration using Otsu thresholding demonstrated a moderate negative correlation (ρ = − 0.75, p < 0.0001). This study included 240 randomly selected patients who underwent shoulder magnetic resonance imaging (MRI) from January 2015 to December 2016. We used a fully convolutional deep-learning algorithm to quantitatively detect the fossa and muscle regions by measuring the occupation ratio of the supraspinatus muscle. Fatty infiltration was objectively evaluated using the Otsu thresholding method. The proposed convolutional neural network exhibited fast and accurate segmentation of the supraspinatus muscle and fossa from shoulder MRI, allowing automatic calculation of the occupation ratio. Quantitative evaluation using a modified Otsu thresholding method can be used to calculate the proportion of fatty infiltration in the supraspinatus muscle. We expect that this will improve the efficiency and objectivity of diagnoses by quantifying the index used for shoulder MRI.

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“…39; 74; 75 Lee et al measured Hounsfields Units (HU) and found a significant correlation between HU measurements and Goutallier grade in CT images (p<0.05). 44 Two other studies used different specialized software to quantitatively grade standard MRI sequences and reported excellent reliability (ICC 0.947 10 , ICC 0.997 43 ) and comparable results to newer Dixon MRI fat fractions and MR spectroscopy fat/water ratios. 10; 43 Both these computer-based techniques present viable alternatives to the Goutallier scale without the need for new imaging modalities, although accessibility of specialized computer programs may be an issue.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 95%

Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment

Bogdanov

Lan

Chu

et al. 2021

JSES Reviews, Reports, and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Threshold-based quantification of fatty degeneration in the supraspinatus muscle on MRI as an alternative method to Goutallier classification and single-voxel MR spectroscopy

Cited by 9 publications

References 30 publications

Advantages of 3–dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice

Advantages of 3–dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice

Deep-learning framework and computer assisted fatty infiltration analysis for the supraspinatus muscle in MRI

Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment

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