Diagnosis of Rotator Cuff Tears with Non-Arthrographic MR Imaging: 3D Fat-Suppressed Isotropic Intermediate-Weighted Turbo Spin-Echo Sequence versus Conventional 2D Sequences at 3T

Won Sun Hong; Won-Hee Jee; So-Yeon Lee; Chang-Woo Chun; Joon-Yong Jung; Yang-Soo Kim

doi:10.13104/imri.2018.22.4.229

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Hong, Jee, Lee, Chun, Jung, and Kim: Diagnosis of Rotator Cuff Tears with Non-Arthrographic MR Imaging: 3D Fat-Suppressed Isotropic Intermediate-Weighted Turbo Spin-Echo Sequence versus Conventional 2D Sequences at 3T

Original Article

iMRI 2018;22(4):229-239.

Published online: 10 January 2018

DOI: https://doi.org/10.13104/imri.2018.22.4.229

Diagnosis of Rotator Cuff Tears with Non-Arthrographic MR Imaging: 3D Fat-Suppressed Isotropic Intermediate-Weighted Turbo Spin-Echo Sequence versus Conventional 2D Sequences at 3T

Won Sun Hong^1,², Won-Hee Jee¹, So-Yeon Lee^1,³, Chang-Woo Chun^1,⁴, Joon-Yong Jung¹, Yang-Soo Kim⁵

¹Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Radiology, Seoul Bumin Hospital, Seoul, Korea

³Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

⁴Department of Radiology, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea

⁵Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Won-Hee Jee, M.D. Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel. +82-2-2258-6238 Fax. +82-2-599-6771 E-mail: whjee12@gmail.com

Received 11 September 2018 Revised 3 November 2018 Accepted 16 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences.

Materials and Methods

Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE.

Results

The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSE-SPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05).

Conclusion

TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

Keywords: Rotator cuff, Magnetic resonance imaging, Non-arthrographic, 3D isotropic, SPACE

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Fig. 1.

Flow diagram of the study. AVN = avascular necrosis; CE = contrast-enhancement; GCT = giant cell tumor; PVNS = pigmented villonodular synovitis; TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image

Fig. 2.

Non-arthrographic MR images show arthroscopically-proven partial-thickness articular-sided tear of the SST-IST in a 68-year-old woman. (a) Oblique coronal fat-suppressed T2-weighted image and (b) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image show a partial-thickness articular-sided tear (arrows) of the SST-IST. All three readers correctly interpreted this case on both 2D sequences and TSE-SPACE.

Fig. 3.

Non-arthrographic MR images show arthroscopically-proven partial-thickness bursal-sided tear of SST-IST and intact SCT in a 55-year-old man. (a) Oblique coronal fat-suppressed T2-weighted image and (b) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image show a partial-thickness bursal-sided tear (arrows) of the SST-IST. (c) Oblique sagittal fat-suppressed T2-weighted image and (d) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image with an oblique sagittal reformatted image show a subtle high signal intensity focus at the articular surface of SCT, which involves the superior portion of the tendon (arrows). A subcortical cyst is noted in the lesser tuberosity of proximal humerus. All three readers correctly interpreted the SST-IST on both 2D sequences and TSE-SPACE. However, they misinterpreted the SCT on both 2D sequences and TSE-SPACE.

Fig. 4.

Non-arthrographic MR images show arthroscopically-proven grade 2 partial-thickness articular-sided tear of the SCT in a 56-year-old woman. (a, b) Axial and oblique sagittal fat-suppressed T2-weighted images and (c, d) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE images with an axial and an oblique sagittal reformation show a high signal intensity area at the articular surface of SCT, which involves more than one third of the craniocaudal diameter of the tendon (arrows). A subcortical cyst is present in the lesser tuberosity of proximal humerus. All three readers correctly interpreted this case on both 2D sequences and TSE-SPACE.

Table 1.

MR Imaging Parameters

Parameter	3D TSE-SPACE	Conventional 2D sequences
Parameter	3D TSE-SPACE	Axial FS T2WI	Coronal FS T2WI	Sagittal FS T2WI	Coronal T2WI	Sagittal T2WI	Coronal FS PDI
Repetition time (ms)	1000	5720	4640	4800	4200	4510	3000
Echo time (ms)	55	57	58	57	58	58	27
Matrix size	192 × 192	512 × 256	512 × 256	512 × 256	512 × 256	512 × 256	448 × 224
Field of view (cm)	140 × 140	140 × 140	140 × 140	140 × 140	140 × 140	140 × 140	140 × 140
Section thickness (mm)	0.6	3	2.5	3	2.5	3	2.5
Intersection gap (mm)	0	0	0	0	0	0	0
Echo train length	127	13	13	13	13	13	4
Bandwidth (Hz/pixel)	457	127	120	120	250	250	120
Imaging time	8 min 24 sec	2 min 34 sec	4 min 48 sec	3 min 58 sec	2 min 55 sec	3 min 14 sec	4 min 11 sec

2D = two-dimensional; 3D TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image; FS = fat-suppressed; PD = proton density; T2WI = T2-weighted images

Table 2.

Diagnostic Performance of Conventional 2D Sequences and 3D TSE-SPACE in Evaluating Rotator Cuff Tears

		Sensitivity			Specificity			Accuracy
		3D TSE-SPACE	2D TSE	P-value	3D TSE-SPACE	2D TSE	P-value	3D TSE-SPACE	2D TSE
SST-IST tear
	Reader1	93 (64/69) [84, 97]	99 (68/69) [92, 100]	0.125	100 (5/5) [57, 100]	100 (5/5) [57, 100]	NA	93 (69/74)	99 (73/74)
FT+PT	Reader2	96 (66/69) [88, 99]	99 (68/69) [92, 100]	0.500	100 (5/5) [57, 100]	80 (4/5) [38, 96]	NA	96 (71/74)	97 (72/74)
	Reader3	96 (66/69) [88, 99]	99 (68/69) [92, 100]	0.500	100 (5/5) [57, 100]	100 (5/5) [57, 100]	NA	96 (71/74)	99 (73/74)
	Reader1	91 (31/34) [77, 97]	97 (33/34) [85, 100]	0.500	95 (38/40) [84, 99]	100 (40/40) [91, 100]	0.500	93 (69/74)	99 (73/74)
PT	Reader2	91 (31/34) [77, 97]	97 (33/34) [85, 100]	0.500	100 (40/40) [91, 100]	98 (39/40) [87, 100]	1.000	96 (71/74)	97 (72/74)
	Reader3	91 (31/34) [77, 97]	97 (33/34) [85, 100]	0.500	100 (40/40) [91, 100]	100 (40/40) [91, 100]	1.000	96 (71/74)	99 (73/74)
	Reader1	94 (33/35) [81, 98]	100 (35/35) [90,100]	0.500	100 (39/39) [91, 100]	100 (39/39) [91, 100]	NA	97 (72/74)	100 (74/74)
FT	Reader2	100 (35/35) [90, 100]	100 (35/35) [90, 100]	NA	100 (39/39) [91, 100]	100 (39/39) [91, 100]	NA	100 (74/74)	100 (74/74)
	Reader3	100 (35/35) [90, 100]	100 (35/35) [90, 100]	NA	100 (39/39) [91, 100]	100 (39/39) [91, 100]	NA	100 (74/74)	100 (74/74)
SCT tear
	Reader1	92 (35/38) [79, 97]	87 (33/38) [73, 94]	0.687	31 (11/36) [18, 47]	61 (22/36) [45, 75]	0.001	62 (46/74)	74 (55/74)
	Reader2	82 (31/38) [67, 91]	87 (33/38) [73, 94]	0.625	50 (18/36) [35, 66]	61 (22/36) [45, 75]	0.219	66 (49/74)	74 (55/74)
	Reader3	87 (33/38) [73, 94]	90 (34/38) [76, 96]	0.000	67 (24/36) [50, 80]	75 (27/36) [59, 86]	0.375	77 (57/74)	82 (61/74)

Data in parentheses are numbers of lesions. Data in square brackets are 95% confidence interval. 2D = two-dimensional; 3D TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image; FT = full-thickness tear; NA = non-applicable; PT = partial-thickness tear; SCT = subscapularis tendon; SST-IST = supraspinatus and infraspinatus tendon

Table 3.

Area Under Receiver Operating Characteristics Curve (AUC) of Three Readers in Evaluating Rotator Cuff Tears

		Reader 1	Reader 2	Reader 3	Reader 1–2 P-value	Reader 1–3 P-value	Reader 2–3 P-value
SST-IST tear
	3D TSE-SPACE	0.964 ± 0.0197	0.959 ± 0.0233	0.957 ± 0.0247	0.863 (−0.045, 0.054)	0.763 (−0.040, 0.054)	0.920 (−0.053, 0.059)
FT+PT	2D TSE	0.991 ± 0.0088	0.975 ± 0.0253	0.987 ± 0.0131	0.544 (−0.036, 0.067)	0.784 (−0.027, 0.036).	0.675 (−0.043, 0.066)
	P-value	0.105 (−0.006, 0.061)	0.612 (−0.047, 0.079)	0.136 (−0.010, 0.071)
	3D TSE-SPACE	0.944 ± 0.0353	0.918 ± 0.0465	0.912 ± 0.0494	0.583 (−0.068, 0.121)	0.472 (−0.056, 0.120)	0.920 (−0.109, 0.121)
PT	2D TSE	0.982 ± 0.0179	0.953 ± 0.0480	0.974 ± 0.0266	0.559 (−0.069, 0.128)	0.786 (−0.055, 0.072)	0.700 (−0.084, 0.125)
	P-value	0.178 (−0.017, 0.094)	0.572 (−0.087, 0.158)	0.132 (−0.019, 0.142)
SCT tear
	3D TSE-SPACE	0.641 ± 0.0581	0.682 ± 0.0538	0.791 ± 0.0495	0.454 (−0.066, 0.147)	0.007 (0.042, 0.258)	0.012 (0.024, 0.194)
	2D TSE	0.798 ± 0.0499	0.794 ± 0.0495	0.865 ± 0.0416	0.910 (−0.066, 0.074)	0.061 (−0.003, 0.136)	0.065 (−0.004, 0.145)
	P-value	0.005 (0.047, 0.268)	0.010 (0.026, 0.199)	0.035 (0.005, 0.143)

Data are AUC values ± standard errors. Data in parentheses are 95% confidence interval.

2D = two-dimensional; 3D TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image; FT = full-thickness tear; NA = non-applicable; PT = partial-thickness tear; SCT = subscapularis tendon; SST-IST = supraspinatus and infraspinatus tendon

Table 4.

Interobserver Agreements of Three Readers in Evaluating Rotator Cuff Tears

		Reader 1–2 P-value	Reader 1–3 P-value	Reader 2–3 P-value
SST-IST tear
FT+PT	3D TSE-SPACE 2D TSE	0.863 (−0.045, 0.054) 0.544 (−0.036, 0.067)	0.763 (−0.040, 0.054) 0.784 (−0.027, 0.036).	0.920 (−0.053, 0.059) 0.675 (−0.043, 0.066)
PT	3D TSE-SPACE 2D TSE	0.583 (−0.068, 0.121) 0.559 (−0.069, 0.128)	0.472 (−0.056, 0.120) 0.786 (−0.055, 0.072)	0.920 (−0.109, 0.121) 0.700 (−0.084, 0.125)
SCT tear
	3D TSE-SPACE	0.454 (−0.066, 0.147)	0.007 (0.042, 0.258)	0.012 (0.024, 0.194)
	2D TSE	0.910 (−0.066, 0.074)	0.061 (−0.003, 0.136)	0.065 (−0.004, 0.145)

2D = two-dimensional; 3D TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image; FT = full-thickness tear; PT = partial-thickness tear; SCT = subscapularis tendon; SST-IST = supraspinatus and infraspinatus tendon

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