Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens

Abstract

IntroductionTreatment of patients with symptoms referable to the rotator cuff depends on location, extent and type of cuff injury. Magnetic resonance imaging and ultrasound are non-invasive imaging methods which are effective for detecting abnormalities of the rotator cuff and biceps tendon [1][2][3][4]. Although both methods are accepted in many routine diagnostic regimens, the results of various studies show a broad range of sensitivity and specificity [5][6][7][8][9][10][11][12]. Statements concerning value and reliability of US and MRI in diagnosis of rotator cuff lesions range from enthusiastic acclaim to critical dismissal. Several factors influence the results of imaging methods in clinical practice. Apart from spatial and contrast resolution, the diagnostic accuracy is determined by the morphological criteria, experience of operator, examination technique, composition of patient collective and reference methods [1].A study on 38 cadaver specimens of shoulder joints was performed to assess the diagnostic value of MRI and US concerning reproducibility of normal joint structures, incidence of artefacts and detection of rotator cuff lesions. Examination on cadaver specimens permits direct comparison of both imaging methods under standardized conditions and verification of diagnostic findings by pathology.Abstract. An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive) and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude t...

Mri Evaluation Of Shoulder Joint: Normal Anatomy & Pathological Finding A Pictorial Essay And Review

“…Tears most frequently occur in areas of tendinosis near the humeral attachment on the major [8,33]. Tendinosis creates increased signal in short TE MRI sequences and may be easier diagnosed if tendon also thickened .…”

To Compare the Diagnostic Consistency of Shoulder MRI and Shoulder US after Rotator Cuff Repair

“…Tüm incelemelerde TSE T1 aksiyel, TSE T2 aksiyel, GRE 3D WATS-c aksiyel, TSE T2 oblik koronal, TSE T1 oblik koronal ve GRE 3D WATS-f oblik koronal sekanslar (5,8).…”

“…Tendon lokalizasyonunun boş olması veya tendonda retraksiyon olması tam kat yırtık olarak kabul edildi. Biseps tendonu uzun başı, tendon oluğunda veya oluk dışında olarak gruplandırıldı (5,8).…”

“…Akromiyoklaviküler eklem içi sıvı miktarı, eklem kapsülünün bombeliği ve eklem mesafesi ile değerlendirildi (5,8).…”

“…Yüksek çözü-nürlüklü yüzeysel ultrasonografi (US) ile yapılan çalışmalarda, sonografinin tendon hasarını saptamada tanısal doğruluğu 81-96 olarak bildirilmiştir (2)(3)(4). Her iki incelemenin rotator kılıf yapıla-rının değerlendirilmesinde duyarlılık ve özgüllük oranları değişik çalışmalarda karşılaştırılmıştır (5,6). Manyetik rezonans görün-tüleme pahalı, uzun zaman alan, manyetik alan içermesi nedeniyle kontrendikasyonları bulunan (kalp pili veya metalik protez bulunan olgularda) ve US'ye kıyasla daha az yaygın bir inceleme yöntemidir.…”