MR imaging detection of adhesive capsulitis of the shoulder: impact of intravenous contrast administration and reader’s experience on diagnostic performance

Abstract

Objective Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader’s experience on sensitivity and specificity of MRI in diagnosing ACS. Materials and methods A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar’s test, t test, and U test (p < .05). Results Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader’s experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant. Conclusion The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader’s experience has shown to be another important factor for the diagnostic outcome.

Diagnostic performance and interreader agreement of individual and combined non-enhanced and contrast-enhanced MR imaging parameters in adhesive capsulitis of the shoulder

“…This becomes even more relevant as ACS usually is self-limiting, however often with a prolonged clinical course and a resistance to therapy, or sometimes too aggressive conservative treatment which may lead to an unfavorable outcome [ 1 , 19 ]. As a correct and reliable radiological diagnosis is fundamental, MRI-based diagnosis is still in the focus of research [ 1 , 5 , 11 , 12 ]. In this study, we aimed to analyze the agreement among readers with different levels of expertise when evaluating established signs of ACS in non-enhanced and CE MR imaging studies.…”

“…The study group consisted of a total of 180 patients who were referred to our outpatient radiology institution and who all received non-enhanced and CE MRI of the shoulder on request of their referring physicians between January 2019 and December 2020. Sixty patients of this group were clinically diagnosed for ACS by experienced orthopedic surgeons based on the consensus definition of Zuckerman et al [ 4 ] which served as the standard of reference, and as done before [ 5 ]: shoulder pain (1), limited active and passive shoulder range of motion (ROM) consisting of reduced anterior flexion (2) and abduction (3) (less than 90° anterior flexion and abduction), and reduced external (4) and internal (5) rotation (less than 50% ER and IR of the contralateral shoulder). The standard of reference was considered positive if 4 of 5 of these signs were clinically present.…”

“…Adhesive capsulitis of the shoulder (ACS) is a common disease in the middle-aged population where patients suffer from painfully reduced active and passive shoulder range of motion [ 1 – 5 ]. Currently, conservative management with physiotherapy and nonsteroidal anti-inflammatory drugs is preferred over arthrolysis or embolization, reserved for cases refractory to conservative treatment [ 6 , 7 ].…”

“…However, there is still controversy about the diagnostic performance of the individual MR imaging signs of capsulitis including the potential benefit of IV contrast application, illustrated by the results of some recent studies [ 1 , 5 , 11 – 13 ]. Chi et al [ 13 ] claimed high performance of non-enhanced imaging, and Ahn et al [ 11 ] found similar performance of non-enhanced and CE imaging, respectively.…”

“…Chi et al [ 13 ] claimed high performance of non-enhanced imaging, and Ahn et al [ 11 ] found similar performance of non-enhanced and CE imaging, respectively. On the other hand, it was shown that the accuracy of imaging signs in contrast-enhanced (CE) MR sequences was superior to imaging signs in non-enhanced sequences [ 5 , 11 , 12 ]; e.g., Pessis et al [ 12 ] found significantly higher area under the curve (AUC) values for CE of the joint capsule in the axillary recess (0.986) and rotator interval (0.921) than for T2 hyperintensity in both locations (0.927 and 0.7). Except a basic analysis in the study of Chi et al [ 13 ], imaging signs were evaluated individually.…”