Repaired Supraspinatus Tendons in Clinically Improving Patients: Early Postoperative Findings and Interval Changes on MRI

Objective

To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs.

Materials and Methods

Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated.

Results

The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050).

Conclusion

Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.     

Grading Anterior Cruciate Ligament Graft Injury after Ligament Reconstruction Surgery: Diagnostic Efficacy of Oblique Coronal MR Imaging of the Knee

Objective

The purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery.

Materials and Methods

We retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups.

Results

The weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone.

Conclusion

The additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury.     

The usefulness of the three-dimensional enhanced T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology: comparison with two-dimensional enhanced T1 fat saturation MR

Objective:

To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T₁ high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for variable shoulder pathology such as rotator cuff tear, labral injury and synovial pathology in comparison with two-dimensional enhanced fast spin echo T₁ fat saturation (2D T1 FS) sequences MR.

Methods:

This retrospective study included 86 patients who underwent MRI of the shoulder using eTHRIVE technique. Two radiologists evaluated anatomic identification of the supraspinatus, glenoid labrum and acromioclavicular joint (AC joint) on routine MRI sequences (2D T1 FS) and compared them with the reformatted eTHRIVE images. Subjective scoring of the images was performed with a four-point scale that rated the degree of discrimination of the shape of the supraspinatus, glenoid labrum and AC joint. The diagnostic accuracy of eTHRIVE compared with routine MR images was evaluated in terms of rotator cuff pathology, labral pathology and synovial pathology.

Results:

Anatomic identification scores of the supraspinatus tendon and labrum were significantly lower for eTHRIVE than for 2D T1 FS. There were no significant differences between eTHRIVE and 2D T1 FS in anatomic identification of the AC joint. There were no significant differences between eTHRIVE and 2D T1 FS in diagnosing the three disease categories.

Conclusion:

eTHRIVE had comparable diagnostic accuracy to 2D T1 FS imaging in the evaluation of rotator cuff tears, labral injury and synovial pathology, but anatomic identification was inferior to that of 2D T1 FS.

Advances in knowledge:

The accuracy of 3D eTHRIVE imaging is comparable to that of 2D T1 FS for the diagnosis of rotator cuff tears, labral injury and synovial pathology.     

Reliability of MRI assessment of supraspinatus tendinopathy

Objective

To determine the interobserver and intraobserver reliability of the interpretation of MRIs for supraspinatus tendinosis.

Methods

In the interobserver trial, the MRIs of 52 athletes'' shoulders were observed by 3 observers on one occasion within a 2‐month period. All 52 images were read by the most experienced musculoskeletal radiologist on 3 different occasions on separate days without access to the previous readings for the intraobserver trial. Supraspinatus tendinosis was graded using a modified 4‐point scale from grades 0 to grade 3.

Results

The grading of MRI‐determined supraspinatus tendinosis was reliable, having an intraclass correlation (ICC) of 0.85 when assessed by the single well‐trained observer. Interobserver reliability was only fair to good (ICC = 0.55).

Conclusions

Supraspinatus tendinosis can be accurately identified on MRI with little variation by a single well‐trained observer. Interobserver reliability was only fair to good. Our data indicated that the reliability of the assessment was much greater in more experienced radiologists than in those with less experience.MRI has proven to be useful in the assessment of rotator cuff injuries. MRI is a non‐invasive method of imaging and is unique in that it allows the differentiation of soft tissue structures.¹ Improvements in MRI techniques, including fast spin‐echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff.The MRI findings of rotator cuff tendinopathy are characterised by thickened inhomogeneous rotator cuff tendon with increased signal intensity on all pulse sequences.² Fluid intensity filling an incomplete gap in the tendon on fat‐suppressed T2‐weighted sequences changes are seen on MRI for partial‐thickness tears.³ On MRI, an area of high signal intensity on all pulse sequences outlines complete disruption of the tendon.⁴MRI is a non‐invasive technique for investigating lesions of the rotator cuff.^{5,6,7,8,9,10,11} It is widely used in clinical practice to investigate shoulder problems in patients, particularly those relating to the rotator cuff and to glenohumeral joint instability. Advances in technology have greatly improved the quality of MRI.Many studies have demonstrated acceptable levels of sensitivity, specificity and accuracy in the diagnosis of cuff and capsulo‐labral pathology.^{12,13,14,15,16,17} The reliability of assessing supraspinatus tendinopathy has not been determined.     

Is coracoacromial arch angle a predisposing factor for rotator cuff tears?

PURPOSE

The aim of the present study was to investigate whether coracoacromial arch angle is a predisposing factor for rotator cuff tears.

METHODS

Shoulder magnetic resonance imaging (MRI) examinations of 40 patients having shoulder arthroscopy due to rotator cuff tears and 28 patients with normal MRI findings were evaluated retrospectively. Acromio-humeral distance, coraco-humeral distance, the angle between the longitudinal axis of the coracoacromial ligament and longitudinal axis of the acromion (coracoacromial arch angle), and thickness of the coracoacromial ligament were measured.

RESULTS

In patients with rotator cuff pathology the mean coraco-humeral distance was 7.88±2.37 mm, the mean acromio-humeral distance was 7.89±2.09 mm, and the mean coracoacromial arch angle was 132.38°±6.52° compared to 11.67±1.86 mm, 11.15±1.84 mm, and 116.95°±7.66° in the control group, respectively (P < 0.001, for all). In regression analysis, all three parameters were found to be significant predictors of rotator cuff tears. The mean thickness of the coracoacromial ligament was not significantly different between the patient and control groups (0.95±0.30 mm vs. 1.00±0.33 mm, P > 0.05).

CONCLUSION

Acromio-humeral and coraco-humeral distances are narrower than normal limits in patients with rotator cuff tears. In addition, coracoacromial arch angle may be a predisposing factor for rotator cuff tears.The most common cause of shoulder pain is rotator cuff pathology, especially in advanced age. Repetitive overhead arm activities, advanced age, morphology of the glenohumeral joint, acromion type, and soft tissue pathologies surrounding the joint have been introduced among its etiologies (1, 2). Neer and et al. (3) defined impingement as a cause of rotator cuff tear in 1972. They also showed that other than shape of the acromion, the coracoacromial ligament and acromioclavicular ligament were associated with tears (3). In later studies it was determined that shoulders with rotator cuff tear had smaller supraspinatus outlet area (4). Burns and Whipple (5) found that the coracoacromial ligament was more effective on impingement than acromion type. Therefore, coracoacromial arch geometry has gained importance and numerous studies, mostly on cadavers, have been performed.The aim of the present study was to investigate whether the coracoacromial arch angle is a predisposing factor for rotator cuff injury.     

Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears

Objective

To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears.

Materials and Methods

The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC).

Results

Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear.

Conclusion

3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.     

Ectopic Insertion of the Pectoralis Minor Tendon: Inter-Reader Agreement and Findings in the Rotator Interval on MRI

Objective

To evaluate magnetic resonance imaging (MRI) observer variability to detect ectopic insertion of the pectoralis minor tendon (EIPMT) and to investigate changes in the rotator interval in patients with EIPMT using MRI.

Materials and Methods

A total of 507 shoulder MRIs (male:female = 259:248; mean age, 55.4 years) were classified into 1) normal type insertion of the pectoralis minor tendon, 2) complete type EIPMT, and 3) partial type EIPMT independently by two radiologists. Inter-observer agreement was calculated using the kappa coefficient. Thickness of the fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess was measured. MRIs were reviewed by consensus with regard to the grade of fibrotic scar tissue proliferation in the rotator interval. Comparisons were made between normal and EIPMT and between partial and complete type EIPMT.

Results

The incidence of EIPMT was 13.4% (complete type, 7.7%; partial type, 5.7%). Inter-observer agreement was substantial (κ = 0.775). Fibrotic scar tissue in the subcoracoid triangle was thicker, and the grade of fibrotic scar tissue proliferation in the rotator interval was higher in the EIPMT group than those in the control group. No significant difference was observed in the thickness of humeral side axillary recess. The thicknesses of fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess as well as the grade of fibrotic scar tissue in the rotator interval were not significantly different between complete and partial type EIPMT.

Conclusion

MRI enabled detection of EIPMT with substantial observer agreement. Patients with EIPMT show a high tendency for fibrotic scar tissue proliferation in the rotator interval.     

Ultrasonographic and MR diagnosis of rotator cuff disorders & shoulder joint instability

Objective

To evaluate the role and efficacy of U/S and MR in diagnosis of rotator cuff disorders and shoulder joint instability.

Patients and methods

This study included 30 patients with shoulder pain and/or movement limitation. They underwent shoulder U/S examination followed by MR examination. The U/S & MR diagnostic criteria of each patient were analyzed, compared and correlated with arthroscopic and/or orthopedic surgical findings.

Results

15 patients had with rotator cuff disorders 15/30 (50%) and 11 patients had shoulder instability 11/30 (36.7%). Out of 15 patients with rotator cuff disorders, 12 patients had rotator cuff tears 12/15 (80%) and 3 patients had tendenosis 3/15(20%). The supraspinatus muscle was involved in all cases (100%), without a significant comparable difference between U/S and MR. Out of 11 patients with shoulder instability 8 patients had anterior labral tear 8/11 (72.7%); 2 patients had superior labral tear 2/11 (18.2%) and only one patient with posterior labral tear.

Conclusion

U/S and MRI are valid diagnostic modalities in detecting, characterizing and discriminating the rotator cuff disorders, with no significant comparable difference. U/S has many challenges in patients with shoulder instability, while MR provides accurate diagnosis even without contrast.     

Diagnostic accuracy on fat-saturated T₂ weighted MRI for diagnosis of intra-articular adhesions of the temporomandibular joint

Objective

The purpose of this study is to compare intra-articular adhesions of the temporomandibular joint (TMJ) between fat-saturated T₂ weighted MR images and arthroscopic findings.

Methods

50 patients (50 joints) with closed locking of the TMJ who were examined with MRI and then underwent arthroscopic surgery participated in this study. The concordance rate of intra-articular adhesions between fat-saturated T₂ weighted MR images and arthroscopic findings was studied using the kappa coefficient.

Results

Intra-articular adhesions were seen on MRI in 21 joints (42%) and in arthroscopic findings in 26 joints (52%). Thus, five joints had false-negative results and mild adhesions were arthroscopically observed in these five joints. There was significant concordance between these two findings (p<0.001). The kappa coefficient was 0.801, which was considered to be complete concordance.

Conclusions

On fat-saturated MRI, a low signal intensity area and narrowing image in the joint space of the TMJ may indicate the presence of intra-articular adhesions or fibrosis.     

Contrast-enhanced MRI of the subdeltoid,subacromial bursa in painful and painless rotator cuff tears

Objective

Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient''s pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder.

Methods

The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain.

Results

There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age.

Conclusion

Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair.

Advances in knowledge

Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear.Rotator cuff tears are a common cause of pain in the shoulder. Surgical repair is an effective treatment, but a significant proportion of patients (5–12.5%) fail to achieve a satisfactory outcome [1-4]. Long-term outcome of surgery correlates poorly with the integrity of the cuff repair [5-7] and persistence of pain is a major factor [1]. In some cases, this may be because the shoulder pain is not due to rotator cuff damage at all [8]. Other painful shoulder pathologies are common, particularly in the elderly, including glenohumeral and acromioclavicular arthritis [9], and bone marrow oedema [10]. Asymptomatic rotator cuff tears are common, with increasing incidence with age and a reported prevalence of up to 80% in subjects aged over 80 years [11]. A significant proportion of these are full-thickness tears with one study reporting full-thickness tears in 28% of people over the age of 60 [12]. Rotator cuff tears may remain asymptomatic despite their large size [13] and, although the size of tears often increases, symptoms may develop or resolve with conservative treatment [14-16]. As yet there is no clear consensus regarding the indications for rotator cuff surgery [17,18]. A technique to determine whether a known rotator cuff tear is responsible for an individual patient''s pain would therefore be of great clinical value in developing patient management plans. While MRI has been shown to be accurate for detecting rotator cuff tears [19,20], there is no convincing evidence to date that it can be used to determine whether a full-thickness tear is symptomatic [12,21].The mechanism by which rotator cuff tears cause pain is poorly understood. Tears are associated with histological inflammation of the subdeltoid/subacromial bursa and this has recently been proposed as a cause of pain [22]. Synovial inflammation in the bursa in symptomatic rotator cuff tears could potentially be detected by the associated enhancement in the inflamed bursa seen on MRI after the administration of intravenous contrast agent, in the same way that synovial volume in joints in inflammatory arthritis has been shown to correlate with histological measures of inflammation [23]. The aim of this study was to use contrast-enhanced MRI to assess subacromial bursitis in patients with painful and painless rotator cuff tears in order to test the hypothesis that synovial enhancement at the subacromial bursa is greater in patients with shoulder pain.     

Comparison of 2- and 3-dimensional shoulder ultrasound to magnetic resonance imaging in a community hospital for the detection of supraspinatus rotator cuff tears with improved worktime room efficiency

Purpose

The purpose of this study was to evaluate whether 3-dimensional (3D) volumetric acquisition of shoulder ultrasound (US) data for supraspinatus rotator cuff tears is as sensitive when compared with conventional 2-dimensional (2D) US and routine magnetic resonance imaging (MRI), and whether there is improved workroom time efficiency when using the 3D technique compared with the 2D technique.

Methods

In this prospective study, 39 shoulders underwent US and MRI examination of their rotator cuff to confirm the accuracy of both the 2D and 3D techniques. The difference in sensitivities was compared by using confidence interval analysis. The mean times required to obtain the 2D and 3D US data and to review the scans were compared by using a 1-tailed Wilcoxon test.

Results

Sensitivity and specificity of 2D US in detecting supraspinatus full- and partial-thickness tears was 100% and 96%, and 80% and 100%, respectively, and similar values were obtained with 3D US at 100% and 100%, and 90% and 96.6%, respectively. Analysis of the confidence limits of the sensitivities showed no significant difference. The mean time (± SD) of the overall 2D examination of the shoulder, including interpretation was 10.02 ± 3.28 minutes, whereas, for the 3D examination, it was 7.08 ± 0.35 minutes. Comparison between the 2 cohorts when using a 1-tailed Wilcoxon test showed a statistically significant difference (P < .05).

Conclusion

3D US of the shoulder is as accurate as 2D US when compared with MRI for the diagnosis of full- and partial-thickness supraspinatus rotator cuff tears, and 3D US examination significantly reduced the time between the initial scan and the radiologist interpretation, ultimately improving workplace efficiency.     

Painful poststroke shoulder: Comparison of magnetic resonance imaging and high frequency ultrasonography

Background

The use of high frequency ultrasound has been increased in the diagnosis of musculoskeletal abnormalities.

Aim

To detect the structural abnormalities in patient with poststroke painful shoulder as a first objective, and the second objective to assess the diagnostic accuracy of US in detecting these abnormalities.

Patients and methods

The study included 106 patients (62 men; mean age, 57 ± 13 years) with shoulder pain after 1st attack of stroke, the patients examined separately by two radiologists, within three months of stroke development with ultrasound and MRI which was done in the same day or as maximum as three days after US examination, the images were reviewed for any abnormalities in rotator cuff, biceps tears, tendinopathies and atrophy, subacromial bursa fluid, and acromioclavicular capsular hypertrophy. MRI results were considered as gold slandered. Sensitivity, specificity, positive and negative predictive values kappa coefficients of the US in comparison with that of the MRI were measured.

Results

Different structural abnormalities detected in our patients and the agreement between ultrasound and magnetic resonance image in detecting these pathologies was good for rotator cuff tear, subacromial bursitis and glenohumeral effusion and very good for biceps tendon pathology, and it was poor for rotator cuff atrophy, ultrasound shows higher sensitivity (90.9%) in detecting full thickness tear of rotator cuff more than partial tear (80%) and with (98.6%) and (97.5%) specificity respectively. The sensitivity for both technique ranging from 90.9% for full thickness tear of rotator cuff to 64.3% for rotator cuff atrophy and the specificity between 98.9% and 97.1%.

Conclusion

high frequency ultrasound provide a high diagnostic accuracy in diagnosing poststoke shoulder pain and it was non expensive and less time-consuming, suitable as screening patients who are obese, have contraindication to MRI examination, allergy to contrast medium, or claustrophobic, and it can be done at bed side in critical patients.     

Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR

Objective:

To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T₁ high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for the detection of rotator cuff tears, labral lesions and calcific tendonitis of the rotator cuff in comparison with two-dimensional (2D) fast spin echo T₂ fat saturation (FS) MR.

Methods:

This retrospective study included 73 patients who underwent shoulder MRI using the eTHRIVE technique. Shoulder MR images were interpreted separately by two radiologists. They evaluated anatomic identification and image quality of the shoulder joint on routine MRI sequences (axial and oblique coronal T₂ FS images) and compared them with the reformatted eTHRIVE images. The images were scored on a four-point scale (0, poor; 1, questionable; 2, adequate; 3, excellent) according to the degree of homogeneous and sufficient fat saturation to penetrate bone and soft tissue, visualization of the glenoid labrum and distinction of the supraspinatus tendon (SST). The diagnostic accuracy of eTHRIVE images compared with routine MRI sequences was evaluated in the setting of rotator cuff tears, glenoid labral injuries and calcific tendonitis of the SST.

Results:

Fat saturation scores for eTHRIVE were significantly higher than those of the T₂ FS for both radiologists. The sensitivity and accuracy of the T₂ FS in diagnosing rotor cuff tears were >90%, whereas sensitivity and accuracy of the eTHRIVE method were significantly lower. The sensitivity, specificity and accuracy of both images in diagnosing labral injuries and calcific tendonitis were similar and showed no significant differences. The specificity of both images for the diagnosis of labral injuries and calcific tendonitis was higher than the sensitivities.

Conclusion:

The accuracy of 3D eTHRIVE imaging was comparable to that of 2D FSE T₂ FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST. The 3D eTHRIVE technique was superior to 2D FSE T₂ FS in terms of fat saturation. Overall, 3D eTHRIVE was inferior to T₂ FS in the evaluation of rotator cuff tears because of poor contrast between joint fluid and tendons.

Advances in knowledge:

The accuracy of 3D eTHRIVE imaging is comparable to that of 2D FSE T₂ FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST.Decreasing MR examination time is important for improving patient comfort and reducing motion artefact.¹ Three-dimensional (3D) MRI with isotropic resolution can create multiplanar reformatted (MPR) images and enable the creation of similar sequences with different image planes, resulting in decreased scan time.^2–4 3D isotropic MR can minimize partial volume artefact using thin slice thickness (SL), which can analyse lesions without interslice gaps.⁵ Recently, a new 3D imaging sequence called 3D enhanced T₁ high-resolution isotropic volume excitation MR (eTHRIVE) was developed.⁶ The eTHRIVE is a 3D T₁ weighted gradient sequence with dual half-scan and improved fat suppression that enables fast dynamic scanning with submillimetre in-plane resolution.⁷ Lee et al⁶ reported that eTHRIVE has the advantage of high-contrast resolution that reveals better diagnostic results through multiplanar reconstruction. These techniques were used to evaluate ligaments of the wrist within a shorter imaging time. However, to the best of our knowledge, no preliminary study has used eTHRIVE to evaluate shoulder joint pathology. The purpose of this study was to evaluate the diagnostic accuracy of eTHRIVE shoulder MR regarding the detection of rotator cuff tears, labral lesions and calcific tendonitis of the rotator cuff in comparison with two-dimensional (2D) fast spin echo T₂ fat saturation (FS) MR.     

Glenohumeral joint translation and muscle activity in patients with symptomatic rotator cuff pathology: An ultrasonographic and electromyographic study with age-matched controls

Objectives

To determine whether patients with symptomatic rotator cuff pathology had more glenohumeral joint translation and different patterns of rotator cuff muscle activity compared to controls.

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

Objective

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.

Materials and Methods

The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.

Results

The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.

Conclusion

MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.     

MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions

Purpose

Diagnosis of partial rotator cuff tears and tendonopathy using conventional MRI has proven variable. Quantitative T2 mapping may have application for assessing rotator cuff health. In order to evaluate the usefulness of T2 mapping for the rotator cuff, methods must be refined for mapping the supraspinatus tendon, and normative T2 values must first be acquired.

Materials and methods

This study was IRB approved. Thirty asymptomatic volunteers (age: 18–62) were evaluated with sagittal and coronal T2 mapping sequences. Manual segmentation of tendon and muscle as a unit and tendon alone was performed twice by two independent raters. Segmentations were divided into medial, middle and lateral subregions and mean T2 values calculated.

Results

Anatomic comparison of mean T2 values illustrated highest values in the medial region, lowest values in the lateral region, and intermediate values for the middle region upon coronal segmentation (p < 0.001). In sagittal segmentations, there were higher values in the medial region and no significant differences between the lateral and middle subregions. No significant differences were found with comparison across age groups. Inter and intra-rater segmentation repeatability was excellent, with coefficients ranging from 0.85 to 0.99.

Conclusion

T2 mapping illustrated anatomic variation along the supraspinatus muscle-tendon unit with low standard deviations and excellent repeatability, suggesting that changes in structure due to degeneration or changes associated with healing after repair may be detectable.     

The science of rotator cuff tears: translating animal models to clinical recommendations using simulation analysis

Purpose

The purpose of this article is to review basic science studies using various animal models for rotator cuff research and to describe structural, biomechanical, and functional changes to muscle following rotator cuff tears. The use of computational simulations to translate the findings from animal models to human scale is further detailed.

Methods

A comprehensive review was performed of the basic science literature describing the use of animal models and simulation analysis to examine muscle function following rotator cuff injury and repair in the ageing population.

Results

The findings from various studies of rotator cuff pathology emphasize the importance of preventing permanent muscular changes with detrimental results. In vivo muscle function, electromyography, and passive muscle–tendon unit properties were studied before and after supraspinatus tenotomy in a rodent rotator cuff injury model (acute vs chronic). Then, a series of simulation experiments were conducted using a validated computational human musculoskeletal shoulder model to assess both passive and active tension of rotator cuff repairs based on surgical positioning.

Conclusion

Outcomes of rotator cuff repair may be improved by earlier surgical intervention, with lower surgical repair tensions and fewer electromyographic neuromuscular changes. An integrated approach of animal experiments, computer simulation analyses, and clinical studies may allow us to gain a fundamental understanding of the underlying pathology and interpret the results for clinical translation.     

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

Purpose

To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials and methods

Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Results

Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively.

Conclusions

In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.     

Systematik der Verletzungen von Rotatorenmanschette und Bizepssehne

Performance

Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically.

Achievements

These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury.

Practical recommendation

Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns.