Korean J Radiol.  2010 Oct;11(5):528-535. 10.3348/kjr.2010.11.5.528.

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

• Chun KA
• Kim MS
• Kim YJ

• KMID: 1102577
• DOI: http://doi.org/10.3348/kjr.2010.11.5.528

Abstract

OBJECTIVE
To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.
MATERIALS AND METHODS
The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.
RESULTS
The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.
CONCLUSION
MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.

Keyword

Shoulder; MR arthrography; Rotator cuff; Partial-thickness tear

MeSH Terms

*Arthroscopy
Chi-Square Distribution
Contrast Media/diagnostic use
Female
Gadolinium DTPA/diagnostic use
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Predictive Value of Tests
Rotator Cuff/*injuries
Sensitivity and Specificity

Figure

• 

  Fig. 1 61-year-old man with articular-sided partial-thickness tear. A. Fat-suppressed oblique coronal T1-weighted image shows defect along undersurface of supraspinatus tendon with no leakage of contrast medium into subacromial-subdeltoid bursa (arrow). B. Fat-suppressed T1-weighted image with abduction external rotation position shows abnormal leakage of contrast medium with delaminating tendon (arrow).

• 

  Fig. 2 47-year-old man with bursal-sided partial-thickness tear. A. Fat-suppressed oblique coronal T1-weighted image shows that bursal surface of distal supraspinatus tendon is irregular (arrow), while articular surface is smooth. There was no contrast spilling within subacromial bursa. B. Oblique coronal T2-weighted image shows irregular delineated high signal intensity area along bursal surface of supraspinatus tendon (arrow).

• 

  Fig. 3 46-year-old man with both articular- and bursal-sided partial-thickness tears. A. Fat-suppressed oblique coronal T1-weighted image shows irregularity along articular surface of supraspinatus tendon (arrow), which represented articular-sided tear. B. Oblique coronal T2-weighted image shows fluid signal in bursa with focal area of high signal intensity involving bursal surface (arrow), which is consistent with bursal-sided tear.

• 

  Fig. 4 53-year-old man with bursal-sided partial-thickness tear. A, B. Oblique coronal fat-suppressed T1- and T2-weighted images show intact tendon. This was false-negative when compared to arthroscopy described as bursal-sided tear.

• 

  Fig. 5 62-year-old woman with both articular- and bursal-sided partial-thickness tears. A, B. Oblique coronal fat-suppressed T1- and T2-weighted images show irregularity of undersurface of supraspinatus tendon with focal accumulation of contrast medium and smooth fat strip along bursal surface, which was interpreted as articular-sided tear. Corresponding arthroscopic record described both articular- and bursal-sided tears.

• 

  Fig. 6 54-year-old man with both articular- and bursal-sided partial-thickness tears. A, B. Oblique coronal fat-suppressed T1- and T2-weighted images show defect of supraspinatus tendon and contrast leakage along subdeltoid-subacromial bursa, which was interpreted as full-thickness tear. Corresponding arthroscopic record described both articular- and bursal-sided tears.

Reference

1. Matava MJ, Purcell DB, Rudzki JR. Partial-thickness rotator cuff tears. Am J Sports Med. 2005. 33:1405–1417.

2. Finnan RP, Crosby LA. Partial-thickness rotator cuff tears. J Shoulder Elbow Surg. 2010. 19:609–616.

3. Meister K, Thesing J, Montgomery WJ, Indelicato PA, Walczak S, Fontenot W. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skeletal Radiol. 2004. 33:136–141.

4. Stetson WB, Phillips T, Deutsch A. The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. J Bone Joint Surg Am. 2005. 87:81–88.

5. Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, et al. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol. 2007. 17:491–498.

6. Robertson PL, Schweitzer ME, Mitchell DG, Schlesinger F, Epstein RE, Frieman BG, et al. Rotator cuff disorders: interobserver and intraobserver variation in diagnosis with MR imaging. Radiology. 1995. 194:831–835.

7. Ferrari FS, Governi S, Burresi F, Vigni F, Stefani P. Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation. Eur Radiol. 2002. 12:1211–1217.

8. Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol. 2009. 192:86–92.

9. Sano H, Ishii H, Trudel G, Uhthoff HK. Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders. J Shoulder Elbow Surg. 1999. 8:574–579.

10. Palmer WE. MR arthrography of the rotator cuff and labral-ligamentous complex. Semin Ultrasound CT MR. 1997. 18:278–290.

11. Vahlensieck M. MRI of the shoulder. Eur Radiol. 2000. 10:242–249.

12. Vanhoenacker FM, Van der Woude HJ, Vanhoenacker PK, De Praeter G. MR arthrography of the rotator cuff. JBR-BTR. 2007. 90:338–344.

13. Jung JY, Jee WH, Chun HJ, Ahn MI, Kim YS. Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: accuracy, and inter- and intra-observer agreements. Acta Radiol. 2010. 51:194–201.

14. Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? Skeletal Radiol. 2009. 38:967–975.

15. Quinn SF, Sheley RC, Demlow TA, Szumowski J. Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients. Radiology. 1995. 195:497–500.

16. McConville OR, Iannotti JP. Partial-thickness tears of the rotator cuff: evaluation and management. J Am Acad Orthop Surg. 1999. 7:32–43.

17. Magee T, Williams D. 3.0-T MRI of the supraspinatus tendon. AJR Am J Roentgenol. 2006. 187:881–888.

18. Ko JY, Huang CC, Chen WJ, Chen CE, Chen SH, Wang CJ. Pathogenesis of partial tear of the rotator cuff: a clinical and pathologic study. J Shoulder Elbow Surg. 2006. 15:271–278.

19. Spencer EE Jr, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008. 36:99–103.

20. Kuhn JE, Dunn WR, Ma B, Wright RW, Jones G, Spencer EE, et al. Interobserver agreement in the classification of rotator cuff tears. Am J Sports Med. 2007. 35:437–441.