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DOI: http://dx.doi.org/10.21088/joe.2454.7956.3217.9

Abstract

Background: Both noninvasive magnetic resonance imaging (MRI) and invasive arthroscopy accomplished remarkable and impressive developments to evaluate shoulder joint [1]. These are achieved by the interaction of radiologists and arthroscopic shoulder surgeons who have shared their clinical experiences and provided feedback of mutual patients. However, the opinion of radiologists and surgeons regarding MR images of the shoulder still has undeniable inconsistencies to this date. Considering imaging modalities like MRI play a decisive role in planning the treatment protocols for patients, it is vital to know to what extent these operator-dependent imaging reports are valid, reliable and informative. Therefore, we studied the sensitivity, specificity, and positive and negative predictive values of MRI for diagnostic evaluation of shoulder disorders and compared the results with arthroscopy. Materials and methods: This is 6 months prospective study from August 2016 to January 2017. A total number of 62 subjects who underwent arthroscopic shoulder surgeries for various pathology were enrolled in the study. Pre-operative MRI was obtained with axial T1, axial T2 FAT SAT, sagittal T1, sagittal T2 FAT SAT and coronal T1 & T2 FAT SAT . Images were reported by a two expert radiologist from the radiology department of our institutions. The radiologist checked all the structures that could be evaluated in arthroscopy according to a checklist provided by the shoulder surgeon. They were biceps tendon, biceps labral complex, labrum, rotator interval, subscapularis tendon, ligaments, head and glenoid cartilages, sub-acromial bursa, supraspinatus and infraspinatus tendons. Patients underwent shoulder arthroscopy under general anesthesia within maximum four weeks. All previously mentioned structures were inspected and probed. With the same prepared checklist, pathologies were saved in detail for future comparison with the radiologist’s MRI report. Then surgical intervention of found pathologies was done as needed. Finally, MRI findings (sensitivity, specificity, and positive and negative predictive values) were compared to arthroscopy findings. Results: Sensitivity of MRI proved to be highest for Hill-Sachs lesion size and location (94.2) and lowest for infraspinatus tendon (61.5). Highest specificity was in tears of biceps tendon (100.0) whereas it was lowest for Humeral head and Glenoid cartilage (81.4). MRI reports were shown to have the most positive predictive value for supraspinatus tendon tears (94.5), while it is lowest for infraspinatus tendon tears (80.0). The highest negative predictive value was found to be 96.08 which was recorded for biceps tendon pathologies (tendinosis and tear). However, detection of anterior labrum lesions possessed the lowest negative predictive value in MRI reports (70.0) Conclusion: MRI can be considered good noninvasive instigation for the assessment of supraspinatus tendon injuries and labral injuries, further research needed with large number patients.

Keywords: Shoulder; Arthroscopy; MRI. 

Corresponding Author : Shivakumar B. Kerakkanavar, Assistant Professor, Department of Orthopaedics, Rajarajeshwari Medical College and Hospital. Kambipura, Mysore Rd, Bengaluru, Karnataka 560074, India.