Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study

Grinsven, Susan van; Nijenhuis, Thijs A.; Konings, Peer C.; Kampen, A. van; Loon, C. J. M. van

doi:10.1016/j.jse.2015.05.050

Cited by 13 publications

(18 citation statements)

References 41 publications

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“…It has been shown that experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder ALAD 4). This was recorded as a truepositive result by all investigators instability-related lesions on MRA or in assessing shoulder impingement [19,33]. These results, although dealing with joints other than the hip, confirm our findings.…”

Section: Discussionsupporting

confidence: 89%

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

Zimmerer

Schneider

Tramountanis

et al. 2021

Arch Orthop Trauma Surg

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Aims To compare the diagnostic accuracy of investigators from different specialities (radiologists and orthopaedic surgeons) with varying levels of experience of 1.5 T direct magnetic resonance arthrography (dMRA) against intraoperative findings in patients with femoroacetabular impingement syndrome (FAIS). Methods A total of 272 patients were evaluated with dMRA and subsequent hip arthroscopy. The dMRA images were evaluated independently by two non-hip-arthroscopy-trained orthopaedic surgeons, two fellowship-trained musculoskeletal radiologists, and two hip-arthroscopy-trained orthopaedic surgeons. The radiological diagnoses were compared with the intraoperative findings. Results Hip arthroscopy revealed labral pathologies in 218 (79%) and acetabular chondral lesions in 190 (69%) hips. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for evaluating the acetabular labral pathologies were 79%, 18%, 79%, 18%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 83%, 36%, 83%, 36%, and 74% (fellowship-trained musculoskeletal radiologists), and 88%, 53%, 88%, 54% and 81% (hip-arthroscopy trained orthopaedic surgeons). The sensitivity, specificity, PPV, NPV and accuracy of dMRA for assessing the acetabular chondral damage were 81%, 36%, 71%, 50%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 84%, 38%, 75%, 52%, and 70% (fellowship-trained musculoskeletal radiologists), and 91%, 51%, 81%, 73%, and 79% (hip-arthroscopy trained orthopaedic surgeons). The hip-arthroscopy trained orthopaedic surgeons displayed the highest percentage of correctly diagnosed labral pathologies and acetabular chondral lesions, which is significantly higher than the other two investigator groups (p < 0.05). Conclusion The accuracy of dMRA on detecting labral pathologies or acetabular chondral lesions depends on the examiner and its level of experience in hip arthroscopy. The highest values are found for the hip-arthroscopy-trained orthopaedic surgeons. Level of evidence Retrospective cohort study; III.

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Section: Discussionsupporting

confidence: 89%

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

Zimmerer

Schneider

Tramountanis

et al. 2021

Arch Orthop Trauma Surg

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“…Sample size was based on expert opinion, numbers of MRIs and respondents in previous studies, [ 19 , 20 , 22 ], and feasibility in terms of the time needed to complete the survey for the set of MRIs. All analyses were performed with Stata ver.…”

Section: Methodsmentioning

confidence: 99%

“…However, the surgeon’s level of expertise was not taken into account, and the overall agreement was fair. van Grinsven et al [ 20 ] has assessed the agreement between radiologists and orthopedic surgeons for instability-related shoulder lesions on MRI, although the study did not report on the number of Hill-Sachs lesions in the population. Furthermore, they reported the agreement for all instability-related shoulder lesions without specifying the agreement for Hill-Sachs lesions.…”

Section: Introductionmentioning

confidence: 99%

Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging

Alkaduhimi¹,

Saarig²,

Amajjar³

et al. 2021

Clin Shoulder Elbow

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Background: Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement. Methods: Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss’ kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction. Results: The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion. Conclusions: Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.

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“…Computed tomography (CT) and MRAs are indicated to identify concomitant injuries and are useful in assessing the size and morphology of glenoid and humeral head defects (Fig. 5) [22][23][24][25]. Specifically, threedimensional reconstructions with digital humeral head Fig.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

The Epidemiology and Natural History of Anterior Shoulder Instability

Galvin

Ernat

Waterman

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. Recent Findings Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. Summary There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.

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Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study

Cited by 13 publications

References 41 publications

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging

The Epidemiology and Natural History of Anterior Shoulder Instability

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