Low accuracy of interpretation of rotator cuff MRI in patients with osteoarthritis

Abstract

BackgroundMagnetic resonance imaging (MRI) is considered to be a valuable tool for the diagnosis of rotator cuff tears in patients with severe glenohumeral osteoarthritis who are indicated for total shoulder arthroplasty (TSA). We determined the sensitivity, specificity, and positive predictive value of MRI in diagnosing rotator cuff tears in such patients.MethodsMRI reports of 100 patients who had completed a shoulder MRI prior to TSA were reviewed to determine the radiologists’ interpretation of the MRI including the diagnosis, presence of a full-thickness cuff tear, and the presence of atrophy and/or fatty infiltration within the rotator cuff muscle bellies. Operative reports were used as a gold standard to determine whether a full-thickness rotator cuff tear was present.ResultsPreoperative MRI reports noted 33 of the 100 patients as having a full-thickness rotator cuff tear, 17 of which had multiple tendon tears. 2 of the 33 patients with full tears on MRI were found to have full-thickness tears at surgery. The sensitivity, specificity, and positive predictive value for MRI detection of full-thickness tears were 100%, 68%, and 6% respectively, with a false-positive rate of 32% and an accuracy of 69%.InterpretationThe study suggests that although MRI is highly sensitive, it has a low positive predictive value and moderately low specificity and accuracy in detecting full-thickness rotator cuff tears in patients with severe glenohumeral osteoarthritis.

Efficacy of Imaging Modalities Assessing Fatty Infiltration in Rotator Cuff Tears

“…However, correlation between MRI and CT for the staging of partial-thickness tears was poor (46%, k 5 20.11) 41 . In addition, tear classification on MRI by radiologists had good agreement with classification by surgeons during arthroscopy (k 5 0.682, p 5 0.001), with a sensitivity, specificity, and positive predictive value of 100%, 68%, and 6%, respectively 42,43 .…”

Rotator Cuff Case Report: Diagnosis and Treatment Using the Biopuncture Protocol

“…Recent investigations in the field of rotator cuff tears have illustrated the diagnostic shortcomings of MRIa (magnetic resonance imaging with arthrography): the test is very specific but not sensitive for rotator cuff tears [17][18][19]. MRIa without arthrography is also highly sensitive, but has a low positive predictive value and low specificity and accuracy in detecting full-thickness rotator cuff tears [20]. The authors of this study postulated that even a total shoulder arthroplasty in patients with severe glenohumeral osteoarthritis is not always built on solid decision making.…”