OJRad  Vol.6 No.2 , June 2016
Comparison with Surgical Findings for the Accuracy of Routine MRI in Rotator Cuff Tears
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.
Cite this paper
Darai, N. , Pokhrel, S. , Shu, R. , Zhang, X. , Liu, J. and Teng, G. (2016) Comparison with Surgical Findings for the Accuracy of Routine MRI in Rotator Cuff Tears. Open Journal of Radiology, 6, 73-83. doi: 10.4236/ojrad.2016.62011.
[1]   Mitchell, C., Adebajo, A., Hay, E. and Carr, A. (2005) Shoulder Pain: Diagnosis and Management in Primary Care. BMJ, 331, 1124-1128.

[2]   Macfarlane, G.J., Hunt, I.M. and Silman, A.J. (1998) Predictors of Chronic Shoulder Pain: A Population Based Prospective Study. The Journal of Rheumatology, 25, 1612-1615.

[3]   Dalton, S.E. (1994) The Conservative Management of Rotator Cuff Disorders. Rheumatology, 33, 663-667.

[4]   Seibold, C.J., Mallisee, T.A., Erickson, S.J., Boynton, M.D., Raasch, W.G. and Timins, M.E. (1999) Rotator Cuff: Evaluation with US and MR Imaging. RadioGraphics, 19, 685-705.

[5]   Iannotti, J.P., Zlatkin, M.B., Esterhai, J.L., Kressel, H.Y., Dalinka, M.K. and Spindler, K.P. (1991) Magnetic Resonance Imaging of the Shoulder. The Journal of Bone & Joint Surgery, American Volume, 73, 17-29.

[6]   Singson, R.D., Hoang, T., Dan, S. and Friedman, M. (1996) MR Evaluation of Rotator Cuff Pathology Using T2- Weighted Fast Spin-Echo Technique with and without Fat Suppression. American Journal of Roentgenology, 166, 1061-1065.

[7]   Rutten, M.J.C.M., Spaargaren, G.-J., van Loon, T., de Waal Malefijt, M.C., Kiemency, L.A.L.M. and Jager, G.J. (2010) Detection of Rotator Cuff Tears: The Value of MRI Following Ultrasound. European Radiology, 20, 450-457.

[8]   Chang, C.Y., Wang, S.F., Chiou, H.J., Ma, H.L., Sun, Y.C. and Wu, H.D. (2002) Comparison of Shoulder Ultrasound and MR Imaging in Diagnosing Full-Thickness Rotator Cuff Tears. Clinical Imaging, 26, 50-54.

[9]   Swen, W.A., Jacobs, J.W., Algra, P.R., et al. (1999) Sonography and Magnetic Resonance Imaging Equivalent for the Assessment of Full-Thickness Rotator Cuff Tears. Arthritis & Rheumatism, 42, 2231-2238.

[10]   Martin-Hervas, C., Romero, J., Navas-Acien, A., Reboiras, J.J. and Munuera, L. (2001) Ultrasonographic and Magnetic Resonance Images of Rotator Cuff Lesions Compared with Arthroscopy or Open Surgery. Journal of Shoulder and Elbow Surgery, 10, 410-415.

[11]   Teefey, S.A., Rubin, D.A., Middleton, W.D., Hildebolt, C.F., Leibold, R.A. and Yamaguchi, K. (2004) Detection and Quantification of Rotator Cuff Tears. Comparison of Ultrasonographic, Magnetic Resonance Imaging, and Arthroscopic Findings in Seventy-One Consecutive Cases. The Journal of Bone & Joint Surgery, American Volume, 86-A, 708-716.

[12]   Fotiadou, A., Vlychou, M., Papadopoulos, P., Karataglis, D.S., Palladas, P. and Fezoulidis, I.V. (2008) Ultrasonography of Symptomatic Rotator Cuff Tears Compared with MR Imaging and Surgery. European Journal of Radiology, 68, 174-179.

[13]   Dinnes, J., Loveman, E., McIntyre, L. and Waugh, N. (2003) The Effectiveness of Diagnostic Tests for the Assessment of Shoulder Pain Due to Soft Tissue Disorders: A Systematic Review. Health Technology Assessment, 7, 1-166.

[14]   Balich, S.M., Sheley, R.C., Brown, T.R., Sauser, D.D. and Quinn, S.F. (1997) MR Imaging of the Rotator Cuff Tendon: Interobserver Agreement and Analysis of Interpretive Errors. Radiology, 204, 191-194.

[15]   Jbara, M., Chen, Q., Marten, P., Morcos, M. and Beltran, J. (2005) Shoulder MR Arthrography: How, Why, When. Radiologic Clinics North America, 43, 683-692.

[16]   Kassarjian, A., Bencardino, J.T. and Palmer, W.E. (2006) MR Imaging of the Rotator Cuff. Radiologic Clinics of North America, 44, 503-523.

[17]   Mink, J.H., Harris, E. and Rappaport, M. (1985) Rotator Cuff Tears: Evaluation Using Double-Contrast Shoulder Arthrography. Radiology, 157, 621-623.

[18]   Goldman, A.B. and Ghelman, B. (1978) The Double-Contrast Shoulder Arthrogram: A Review of 158 Studies. Radiology, 127, 655-663.

[19]   Awerbuch, M.S. (2008) The Clinical Utility of Ultrasonography for Rotator Cuff Disease, Shoulder Impingement Syndrome and Subacromial Bursitis. The Medical Journal of Australia, 188, 50-53.

[20]   Luime, J.J., Koes, B.W., Hendriksen, I.J., et al. (2004) Prevalence and Incidence of Shoulder Pain in the General Population; A Systematic Review. Scandinavian Journal of Rheumatology, 33, 73-81.

[21]   Milgrom, C., Schaffler, M., Gilbert, S. and van Holsbeeck, M. (1995) Rotator Cuff Changes in Asymptomatic Adults: The Effect of Age, Hand Dominance, and Gender. The Journal of Bone & Joint Surgery, 77, 296-298.

[22]   Naqvi, G.A., Jadaan, M. and Harrington, P. (2009) Accuracy of Ultrasonography and Magnetic Resonance Imaging for Detection of Full Thickness Rotator Cuff Tears. International Journal of Shoulder Surgery, 3, 94-97.

[23]   Robertson, P.L., Schweitzer, M.E., Mitchell, D.G., et al. (1995) Rotator Cuff Disorders: Interobserver and Intraobserver Variation in Diagnosis with MR Imaging. Radiology, 194, 831-835.

[24]   Lee, C.S., Davis, S.M., McGroder, C., Kouk, S., Sung, R.M., Stetson, W.B. and Powell, S.E. (2014) Analysis of Low-Field MRI Scanners for Evaluation of Shoulder Pathology Based on Arthroscopy. Orthopaedic Journal of Sports Medicine, 2, Article ID: 2325967114540407.

[25]   Waldt, S., Bruegel, M., Mueller, D., et al. (2007) Rotator Cuff Tears: Assessment with MR Arthrography in 275 Patients with Arthroscopic Correlation. European Radiology, 17, 491-498.

[26]   Escobedo, E.M., Hunter, J.C., Hollister, M.C., Pattern, R.M. and Goldstein, B. (1997) MR Imaging of Rotator Cuff Tears in Individuals with Paraplegia. American Journal of Roentgenology, 168, 919-923.

[27]   Iannotti, J.P. and Kwon, Y.W. (2005) Management of Persistent Shoulder Pain: A Treatment Algorithm. The American Journal of Orthopedics, 34, 16-23.

[28]   Roberts, C.S., Galloway, K.P., Honaker, J.T., Hulse, G. and Seligson, D. (1998) Sonography for the Office Screening of Suspected Rotator Cuff Tears: Early Experience of the Orthopedic Surgeon. The American Journal of Orthopedics, 27, 503-506.

[29]   Al-Shawi, A., Badge, R. and Bunker, T. (2008) The Detection of Full Thickness Rotator Cuff Tears Using Ultrasound. The Bone & Joint Journal, 90, 889-892.