Reliability of a 3 T MRI protocol for objective grading of supraspinatus tendonosis and partial thickness tears

Journal of Orthopaedic Surgery and Research

Ming-Hao Zheng¹  William Breidahl³  Charley Budgeon²  Robert Nairn³  Michael Fallon³  Rodney Butler³  Allan Wang⁴  Stefan Bauer⁴ 

[1] School of Surgery, Centre of Orthopaedic Research, The University of Western Australia, 35, Stirling Highway, Crawley, 6009, Western Australia;Centre of Applied Statistics, The University of Western Australia, 35, Stirling Highway, Crawley, 6009, Western Australia;Perth Radiological Clinic, 127 Hamersly Road, Subiaco, 6009, Australia;Department of Orthopaedic Surgery, Sir Charles Gairdner University Hospital, Perth 6904, Subiaco, Australia

关键词: Reliability;    Intra-observer;    Inter-observer;    MRI;    Tendonosis;    Tendonopathy;    Partial thickness supraspinatus tear;   

Others  :  1138826
DOI  :  10.1186/s13018-014-0128-x

 received in 2014-10-05, accepted in 2014-11-24,  发布年份 2014

【 摘 要 】

Background

Partial thickness supraspinatus tears and tendonosis can be managed either nonoperatively or by various arthroscopic techniques. New biologic treatment approaches are currently being investigated. MRI is commonly used for objective imaging outcome evaluation but there is a lack of reliability studies. We propose a novel MRI classification of partial supraspinatus tears and tendonosis and evaluate its inter-observer and intra-observer reliability.

Methods

Digital MRI scans (3 Tesla) of 65 patients investigated for assessment of supraspinatus pathology or subacromial impingement were evaluated by three independent and experienced musculoskeletal (MSK) radiologists. Tendonosis (absent, focal, generalized), partial thickness (PT) tears (absent, 0%–25% PT, 25%–50% PT, 50%–100% PT, and full thickness tears), and anteroposterior extent of tears (less than 5 mm, 5–10 mm, greater than 10 mm) were scored by each radiologist on two separate occasions (t1, t2), 2 months apart. The inter-observer and intra-observer agreement and weighted kappa values for each parameter were calculated.

Results

The range of weighted intra-observer kappa (IAK) was 0.84–0.93 for evaluation of tendonosis; 0.84 (all raters) for depth of partial thickness, 0.74–0.84 for AP tear size, and 0.83–0.85 for the total score. The range of weighted inter-observer kappa (IEK) over two time points (t1, t2) was 0.55–0.74 for tendonosis, 0.69–0.84 for depth for partial thickness tears, 0.57–0.80 for AP tear size, and 0.63–0.80 for the total score.

Conclusion

A comprehensive MRI grading protocol is proposed and is reliable for the evaluation of supraspinatus tendonosis and partial thickness tears with good to excellent kappa values. This rotator cuff MRI protocol can be applied to evaluate morphological tendon outcomes after different treatment modalities.

【 授权许可】

   
2014 Bauer et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Balich SM, Sheley RC, Brown TR, Sauser DD, Quinn SF: MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology 1997, 204(1):191-194.
• [2]Khazzam M, Kuhn JE, Mulligan E, Abboud JA, Baumgarten KM, Brophy RH, Jones GL, Miller B, Smith M, Wright RW: Magnetic resonance imaging identification of rotator cuff retears after repair: interobserver and intraobserver agreement. Am J Sports Med 2012, 40(8):1722-1727.
• [3]Spencer EE Jr, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, Ma CB, Jones G, Safran M, Holloway GB, Kuhn JE: Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med 2008, 36(1):99-103.
• [4]Seitz AL, McClure PW, Finucane S, Boardman ND, Michener LA: Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech Bristol Avon 2011, 26(1):1-12.
• [5]Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB: Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995, 77(1):10-15.
• [6]Yamanaka K, Matsumoto T: The joint side tear of the rotator cuff. A followup study by arthrography. Clin Orthop 1994, 304:68-73.
• [7]Cordasco FA, Backer M, Craig EV, Klein D, Warren RF: The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med 2002, 30(2):257-260.
• [8]Miller SL, Hazrati Y, Cornwall R, Hayes P, Gothelf T, Gladstone JL, Flatow EL: Failed surgical management of partial thickness rotator cuff tears. Orthopedics 2002, 25(11):1255-1257.
• [9]Liem D, Alci S, Dedy N, Steinbeck J, Marquardt B, Möllenhoff G: Clinical and structural results of partial supraspinatus tears treated by subacromial decompression without repair. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2008, 16(10):967-972.
• [10]Brockmeier SF, Dodson CC, Gamradt SC, Coleman SH, Altchek DW: Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2008, 24(8):961-965.
• [11]Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K: Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am 2009, 91(5):1055-1062.
• [12]Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K: Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med 2013, 41(11):2609-2616.
• [13]Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N, Denaro V: Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med 2011, 39(2):258-265.
• [14]Ruiz-Moneo P, Molano-Muñoz J, Prieto E, Algorta J: Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2013, 29(1):2-9.
• [15]Wang AW, Bauer S, Goonatillake M, Breidahl W, Zheng M-H: Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete.BMJ Case Rep 2013, 2013. doi: 10.1136/bcr-2012-007899.
• [16]Sein ML, Walton J, Linklater J, Harris C, Dugal T, Appleyard R, Kirkbride B, Kuah D, Murrell GAC: Reliability of MRI assessment of supraspinatus tendinopathy. Br J Sports Med 2007, 41(8):e9.
• [17]Sugaya H, Maeda K, Matsuki K, Moriishi J: Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am 2007, 89(5):953-960.
• [18]Tuite MJ: Magnetic resonance imaging of rotator cuff disease and external impingement. Magn Reson Imaging Clin N Am 2012, 20(2):187-200. ix
• [19]Kjellin I, Ho CP, Cervilla V, Haghighi P, Kerr R, Vangness CT, Friedman RJ, Trudell D, Resnick D: Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 1991, 181(3):837-841.
• [20]Nakagaki K, Ozaki J, Tomita Y, Tamai S: Magnetic resonance imaging of rotator cuff tearing and degenerative tendon changes: correlation with histologic pathology. J Shoulder Elb Surg Am Shoulder Elb Surg Al 1993, 2(3):156-164.
• [21]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.