Subscapularis tendon tear detection using axial internal rotation MRI: semiquantitative and quantitative analysis
Issued Date
2023-01-01
Resource Type
ISSN
22234292
eISSN
22234306
Scopus ID
2-s2.0-85178471114
Journal Title
Quantitative Imaging in Medicine and Surgery
Volume
13
Issue
12
Start Page
8274
End Page
8289
Rights Holder(s)
SCOPUS
Bibliographic Citation
Quantitative Imaging in Medicine and Surgery Vol.13 No.12 (2023) , 8274-8289
Suggested Citation
Siriwanarangsun P., Pakdee W., Pisanuwongse A., Keyurapan E., Lektrakul N. Subscapularis tendon tear detection using axial internal rotation MRI: semiquantitative and quantitative analysis. Quantitative Imaging in Medicine and Surgery Vol.13 No.12 (2023) , 8274-8289. 8289. doi:10.21037/qims-23-273 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91419
Title
Subscapularis tendon tear detection using axial internal rotation MRI: semiquantitative and quantitative analysis
Author's Affiliation
Other Contributor(s)
Abstract
Background: Magnetic resonance image (MRI) of the subscapularis tendon plays an important role in preoperative planning. This retrospective study aimed to evaluate the diagnostic value and quantitative measurement of an additional internal rotation sequence in the detection of partial subscapularis tendon tears. Methods: The study included 76 patients who underwent arthroscopy and magnetic resonance (MR) shoulder between January 2018 to December 2019. Three different sets of images were evaluated in each case to determine the diagnostic value in the detection of partial subscapularis tendon tears including Set 1: standard axial fat-suppressed proton density (PD/FS) image and sagittal fat-suppressed T2 weight image (T2W/FS) images, Set 2: standard axial PD/FS and internal rotation PD/FS images, and Set 3: standard axial PD/FS, sagittal T2W/FS and axial internal rotation PD/FS images. Subscapularis tendon tear was diagnosed by arthroscopy and patients with or without tears were grouped. The coracohumoral distance (CHD), coracoglenoid angle (CGA), coracohumeral angle (CHA), CHD difference and CHD ratio were evaluated and compared between groups using univariate and multivariate analysis. The interreader agreement was assessed. The cut-off point for the prediction of subscapularis tears was calculated. Results: Twenty-nine shoulders revealed partial subscapularis tendon tears (29/76, 38.2%). Imaging Set 3 provided the highest sensitivity and accuracy {79–83% [confidence interval (CI): 0.60–0.95], 75–76% (CI: 0.63–0.85)}, compared to image Set 2 [31–58% (CI: 0.15–0.76), 67–68% (CI: 0.55–0.79)] and Set 1 [17–21% (CI: 0.06–0.40], 61–66% (CI: 0.54–0.76)], and a moderate level of interobserver agreement (Kappa =0.55). Axial CHD [odd ratio (OR) =1.48, P=0.044], internal rotate CHD (OR =0.68, P=0.02), CHD difference (OR =2.58, P<0.001), and CHD ratio (OR =1.34, P<0.001) were associated with subscapularis tears. A CHD difference and CHD ratio of more than 0.04 mm and 1.01 achieved a 90% sensitivity and 72% specificity, both. Conclusions: Internal rotation during MRI can increase diagnostic accuracy for subscapularis tendon partial tears. The CHD differences and CHD ratio are useful parameters to indicate subscapularis tears. This technique may improve preoperative management and reduce the consequences of delayed diagnosis and treatment.