Correlation between MRI and arthroscopy findings inrotator cuff tears
Keywords:supraspinatus tendon tears, infraspinatus tendon tears, subscapularis tendon tears, teres minor tendon tears.
Introduction: Rotator cuff tears are one of the most common causes of shoulder pain causing significant disability. 86% of patients with shoulder pain are due to the abnormality of rotator cuff disorders. MRI has revolutionized the diagnosis of shoulder pathologies. MRI is a proved sensitive, accurate, cost-effective and a non-invasive tool in investigating shoulder pathology. Currently, Arthroscopy is considered as the “reference standard” for the diagnosis of shoulder pathologies. Aim/purpose: The purpose of this study attempted to assess the sensitivity and specificity of MRI with gold standard of direct visualization under arthroscope for individual rotator cuff tendons injury. Materials and methods: This is a hospital based prospective and comparative study conducted in the department of Radio diagnosis, Apollo Hospitals, Jubilee hills, Hyderabad between march 2019 to September 2020. 75 patients of both sexes and age groups > 18years (minimum and maximum age of the patient seen in my study are 20 years and 86 years respectively) with history of shoulder pain, restricted movements, instability and injuries who underwent MRI investigation and subsequently underwent ARTHROSCOPY.Data was collected on a pre-designed proforma by detailed history, thorough radiological investigations followed by arthroscopy findings. The data was collected analysed and reported as Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Accuracy of MRI for each type of rotator cuff tendon tears. Correlation between MRI and Arthroscopy was done using Kappa statistics and p value. The whole data obtained was analyzed using Statistical Package for Social Sciences, version 23.0. Results: MRI examination showed all 75 patients had supraspinatus tears of which 43 are full thickness tears and 32 are partial thickness tears, 19 out of 75 patients had infraspinatus tears of which 14 are full thickness tears and 5 are partial thickness tears and 15 out of 75 patients had subscapularis tendon tears. There is no teres minor tendon tears reported in the present study. Supraspinatus tendon tears: In the present study arthroscopically proven supraspinatus tendon tears are 39(F) full thickness tears and 22 partial thickness tears (P 1 16 + P2 6). The sensitivity, specificity, PPV, NPV and accuracy of MRI in full thickness supraspinatus tears is 79.6%, 84.6%, 90.7, 68.8 and 81.3 respectively. Kappa value is 0.609(substantial) and p value was <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial articular surface tears is 80.0%, 83.6%, 64.0, 92 and 82.6. Kappa value is 0.589(moderate) and p value is <0.01, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial bursal surface tears are 100%, 98.6%, 85.7, 100.0. and 98.6 respectively. Kappa value is 0.916(almost perfect) and p value is <0.01, highly significant. Infraspinatus tendon tears: Out of 19 (F 14 + P 5) cases arthroscopically proven infraspinatus tendon tears are 10 full thickness tears and 5 partial thickness tears (P). The sensitivity, specificity, NPV and accuracy value of MRI in full thickness infraspinatus tears are 100 % ,93.8%, 71.4,100 and 94.7. Kappa value is 0.803(almost perfect) and p value is <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy value of MRI in partial thickness infraspinatus tears are 55.6%, 100%, 100, 94.3. and 94.7. Kappa value is 0.687(substantial) and p value is <0.001, highly significant. Subscapularis tendon tears: Out of 15 cases in the present study arthroscopically proven subscapularis tendon tears are 11 partial thickness tears (P). The sensitivity specificity, NPV and accuracy of MRI in the detection of subscapularis tears is 100%, 93.8%, 73.3, 100 and 94.7. Kappa value is 0.815(almost perfect) and p value is <0.001, highly significant. Conclusion: In the present study accuracy in detecting full thickness and partial thickness tears in infraspinatus and subscapularis and partial tears of supraspinatus is high as compared to supraspinatus full thickness tears. On comparing results of individual tendon tears in our study suggests, that Magnetic resonance imaging has high sensitivity, specificity and accuracy in diagnosing full thickness and partial thickness tears of supraspinatus tendon tears, subscapularis tears and full thickness tears of infraspinatus tendons. Sensitivity in detecting infraspinatus tendon partial thickness tears was lower, however it has high specificity and accuracy
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Copyright (c) 2022 Mohd Abdul Rawoof, Karanam Poorna Sasank, Esparanto Sudanagunta, Peethamber Lokanandi, Chandra Rakesh Chowdary
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