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Abstract
Purpose
The purpose of this study is to determine whether adding an angled oblique sagittal plane to the routine shoulder MRI improves the diagnostic performance in the evaluation of supraspinatus tendon tears with arthroscopic correlation.
Materials and Methods
The study included 121 patients who had a shoulder MRI followed by arthroscopy. Two radiologists separately evaluated the supraspinatus tendon for tears on shoulder MRI either with or without the angled oblique sagittal images. Arthroscopy was used as the reference standard. The sensitivity and specificity for diagnosing supraspinatus tendon tears were calculated and compared by using McNemar test. Interobserver and intertechnique variability in the interpretation of supraspinatus tendon tears were calculated as a kappa value.
Results
Adding the angled oblique sagittal images to the standard shoulder MRI showed improvement in the sensitivity for diagnosing full-thickness supraspinatus tendon tears and also in the sensitivity, specificity and accuracy for the detection of partial-thickness tears. However, there was no statistically significant difference in all of them between with and without the angled set. Interobserver agreement was substantial to almost perfect and intertechnique agreement was moderate.
Figures and Tables
Fig. 1
Oblique coronal fat-suppressed fast spin-echo T2-weighted image (TR/TE, 4050/97) through the mid-glenoid fossa with the angled oblique sagittal image locations oriented perpendicular to the down-sloping lateral rotator cuff tendon (dashed lines).
Fig. 2
A 54-year-old women with a full-thickness supraspinatus tendon tear at arthroscopy. Oblique sagittal T2-weighted image (a) and oblique coronal fat-suppressed T2-weighted image (b) showed a focal area of increased signal (arrowheads) within the articular surface of the tendon. Angled oblique sagittal T2-weighted image showed linear high signal (arrowheads) extending from the articular to the bursal surface of the tendon (c). Arthroscopy confirmed the full-thickness supraspinatus tendon tear and repair was done (d).
Fig. 3
The false-positive partial-thickness tear of the supraspinatus tendon in 48-year-old women. Oblique sagittal T2-weighted image (a) and oblique coronal fat-suppressed T2-weighted image (b) showed a faint area of increased signal (arrow) within the bursal surface of the tendon. Angled oblique sagittal T2-weighted image also showed a faint increased signal (arrow) (c). This was scored as a partial-thickness tear by reader 1 and 2, however, there was impingement syndrome with no rotator cuff tear at arthroscopy (d).
Fig. 4
The false-negative partial-thickness tear of the supraspinatus tendon in 39-year-old man. Oblique sagittal T2-weighted image (a) and oblique coronal fat-suppressed T2-weighted image (b) showed intrasubstance with increased signal intensity (within the dashed line), which is lower than the signal intensity of the joint fluid. Angled oblique sagittal T2-weighted image showed a diffuse area of intermediate signal intensity (within the dashed line) (c). This patient was suggested with fraying of supraspinatus tendon with findings of underlying rotator cuff impingement at MRI by reader 1 and 2. However, articular view at arthroscopy showed the partialthickness tear at the articular surface of the supraspinatus tendon (arrow) (d).
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