MR imaging detection of adhesive capsulitis of the shoulder: impact of intravenous contrast administration and reader’s experience on diagnostic performance

Bernd Erber,Nina Hesse,Christian Glaser,Sophia Goller,Andreas Heuck,Jens Ricke,Andrea Baur-Melnyk

doi:10.1007/s00256-022-03994-x

Abstract

ObjectiveCorrect identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader’s experience on sensitivity and specificity of MRI in diagnosing ACS.Materials and methodsA total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar’s test, t test, and U test (p < .05).ResultsUsing non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader’s experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant.ConclusionThe addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader’s experience has shown to be another important factor for the diagnostic outcome.

Highlights

Adhesive capsulitis of the shoulder (ACS) is a common, but still poorly understood condition of the shoulder [1]
The disease is classified into an idiopathic primary form and a secondary form which is caused by previous trauma, surgery, or other diseases [6]
Between January 2019 and December 2020, sixty patients with clinical signs of ACS and no history or evidence of previous shoulder surgery, shoulder trauma, previously known rotator cuff tear or labral lesion, calcific tendinosis, rheumatoid or septic arthritis, osteoarthritis > grade 1 according to the Kellgren-Lawrence classification [17], or neurologic deficit were identified in the patient population referred to our outpatient radiology institution, who all received non-enhanced and CE MRI of the shoulder on request of their referring physicians

Summary

Introduction

Adhesive capsulitis of the shoulder (ACS) is a common, but still poorly understood condition of the shoulder [1]. ACS mostly occurs in the middle-aged population and women are more often affected than men [4, 5]. The disease is classified into an idiopathic primary form and a secondary form which is caused by previous trauma, surgery, or other diseases [6]. Skeletal Radiology (2022) 51:1807–1815 into four stages and primary ACS is usually a self-limiting condition with a mean duration of symptoms between 18 and 24 months [3, 7, 8]. The primary form may be associated with diabetes mellitus or autoimmune disorders [9]. ACS is considered a fibrotic capsular disease with proliferation of fibroblasts and chronic inflammatory cells, predominantly in the rotator interval and the axillary recess [10]

Methods

Results

Conclusion