Abstract
Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%; and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved; and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.
Highlights
Rotator cuff tears (RCT) are one of the most common causes of shoulder pain for which patients seek treatment
The objective of this study is to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) in RCT and compare the accuracy of MRI for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears (FTT) using surgical findings as the “gold standard” and to improve the previous MRI accuracy for diagnosing RCT considering more variables
The indications to perform MRI were clinical suspicion for having injury of rotator cuff muscles and intra- and extra-articular structures of the shoulder joint that are responsible for restriction of normal shoulder movement (n = 45), as a request for more diagnostic certainty who were previously suspected in another center as rotator cuff injury (n = 19), the patients who didn’t improve by medical and conservative management (n = 11) and of the remaining patients (n = 6), the indication to do MRI could not be assessed
Summary
Rotator cuff tears (RCT) are one of the most common causes of shoulder pain for which patients seek treatment. Thirty to seventy percent of patients having shoulder pain are due to abnormality of rotator cuff [1] [2]. MRI became the favored investigation for preoperative diagnosis of partial- and full-thickness rotator cuff tears as it can confirm a suspected RCT non-invasively [4]-[6]. It can reveal the RCT for necessary surgical procedures its accuracy greatly depends on the skill of the reporters in interpreting a MRI slides. On the basis of availability, clinical experience and the expected sensitivity and specificity, accuracy of MRI can be assessed [7]
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