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

Abstract

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.

With the exception of the Hill–Sachs interval, CT and MRI show no significant differences in the diagnostic value of the HSL measurement regardless of the measurement technique

“…Studies investigating the diagnostic validity of MRI for the measurement of HSLs are also scarce [2,46,47]. Gyftopoulos et al found an intra-and inter-rater correlation for the The current study is subject to several limitations.…”

“…Studies investigating the diagnostic validity of MRI for the measurement of HSLs are also scarce [2, 46, 47]. Gyftopoulos et al found an intra‐ and inter‐rater correlation for the measurement of HSLs with the on‐track, off‐track method with MRI of 0.86 and 0.79, respectively.…”

“…[1, 22, 24, 26, 43]. Consequently, the reliable detection, localisation, and measurement of HSLs are fundamental for planning adequate surgical treatment, avoiding unnecessary interventions, and reducing health care costs [2, 3, 34, 45]. Different imaging diagnostic modalities, including anterior–posterior (AP)‐view radiographs, Stryker Notch‐(SN) view radiographs, computed tomography (CT), and magnetic resonance imaging (MRI), have been proposed for the detection of HSLs [6, 20, 49].…”

Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair

“…The largest length and depth of the Hill–Sachs lesion were measured, and these lesions were classified as no, minimal (< 1 cm), and definite (> 1 cm) (Fig. 2) [1, 6]. All radiologic evaluations were performed by three trained shoulder fellows (S.C.K, J.H.P, and H.B) blinded to the study population.…”

“…In addition, the presence of bony Bankart lesions and the size of Hill–Sachs lesions were assessed [11]. Hill–Sachs lesions were measured in the coronal view at the just lower cut of the upper humerus tip and medial to the infraspinatus insertion [1, 19]. The largest length and depth of the Hill–Sachs lesion were measured, and these lesions were classified as no, minimal (< 1 cm), and definite (> 1 cm) (Fig.…”