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Published online before print May 18, 2006, 10.1148/radiol.2393050453
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(Radiology 2006;240:152-160.)
© RSNA, 2006

Musculoskeletal Imaging

Indirect MR Arthrography of the Shoulder: Use of Abduction and External Rotation to Detect Full- and Partial-Thickness Tears of the Supraspinatus Tendon1

Thomas Herold, MD, Maike Bachthaler, MD, Okka W. Hamer, MD, Reiner Hente, MD, Stefan Feuerbach, MD, Claudia Fellner, PhD, Michael Strotzer, MD, Markus Lenhart, MD and Christian Paetzel, MD

1 From the Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany. Received March 18, 2005; revision requested May 12; revision received May 27; accepted June 21; final version accepted August 11. Address correspondence to T.H. (e-mail: thomas.herold{at}klinik.uni-regensburg.de).

Purpose: To evaluate prospectively the accuracy of indirect magnetic resonance (MR) arthrography for supraspinatus tendon tears during neutral positioning or abduction and external rotation (ABER) and neutral positioning.

Materials and Methods: Informed consent was obtained in all patients, and the study was approved by the institutional review board. Indirect MR arthrography of the shoulder was performed in 51 symptomatic patients (14 female, 37 male; mean age, 47 years) in the neutral position (set 1) and in the neutral and ABER positions (set 2). Two readers independently interpreted both sets, and diagnoses were compared with arthroscopic findings. Diagnostic accuracy was calculated, and 95% confidence intervals were used to detect significant differences between sets. Diagnostic confidence was recorded by using a three-level confidence score. Differences between sets were evaluated by using the Wilcoxon signed rank test. Interobserver agreement was determined separately for each set and for all diagnoses, full-thickness tears, and partial-thickness tears.

Results: For full-thickness tears, there was no benefit to reading set 2. For reader 1, sensitivity and specificity were 95% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 80% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For partial-thickness tears, sensitivity was significantly higher after reading set 2. For reader 1, sensitivity and specificity were 71% and 88%, respectively, for set 1 and 93% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 50% and 88%, respectively, for set 1 and 86% and 94%, respectively, for set 2. For both readers, diagnostic confidence for partial-thickness tears was significantly higher after reading set 2. After the interpretation of set 2, {kappa} values increased from 0.35 to 1.00 for full-thickness tears and from 0.12 to 0.63 for partial-thickness tears.

Conclusion: Indirect MR arthrography with supplementary images obtained with patients in the ABER position significantly improved sensitivity and increased diagnostic confidence for partial-thickness tears of the supraspinatus tendon. Interobserver agreement was improved for both full- and partial-thickness tears.

© RSNA, 2006




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