Diagnostic imaging of shoulder rotator cuff lesions

Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US) and magnetic resonance imaging (MRI). Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001). We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

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Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

American Journal of Sonography ◽

10.25259/ajs-22-2018 ◽

2018 ◽

Vol 1 ◽

pp. 9

Author(s):

Harshad Arvind Vanjare ◽

Jyoti Panwar

Keyword(s):

Rotator Cuff ◽

Negative Predictive Value ◽

Rotator Cuff Tear ◽

Predictive Value ◽

Rotator Cuff Tears ◽

Mri Findings ◽

Cuff Tear ◽

Experienced Operator ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

10.25259/ijmsr_21_2019 ◽

2019 ◽

Vol 1 ◽

pp. 2-6

Author(s):

Asad Naqvi ◽

Timothy Ariyanayagam ◽

Mir Akber Ali ◽

Akhila Rachakonda ◽

Hema N. Choudur

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Strength Training ◽

Radiology Department ◽

Resonance Imaging ◽

Subacromial Space ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

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Characteristic Retear Patterns Assessed by Magnetic Resonance Imaging After Arthroscopic Double-Row Rotator Cuff Repair

Yearbook of Orthopedics ◽

10.1016/j.yort.2012.05.006 ◽

2012 ◽

Vol 2012 ◽

pp. 217-218

Author(s):

B.F. Morrey

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Resonance Imaging ◽

Double Row ◽

Cuff Repair

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MRI may be able to identify the origin of neuroendocrine tumor liver metastases

Neuroendocrinology ◽

10.1159/000513015 ◽

2020 ◽

Author(s):

Maxime Barat ◽

Philippe Soyer ◽

Fatima Al Sharhan ◽

Benoit Terris ◽

Ammar Oudjit ◽

...

Keyword(s):

Multivariate Analysis ◽

Neuroendocrine Tumors ◽

Interobserver Agreement ◽

Validation Cohort ◽

Univariate Analysis ◽

Intraclass Correlation ◽

Hepatic Metastases ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objectives: To discriminate hepatic metastases from pancreatic neuroendocrine tumors (pNET) and hepatic metastases from midgut neuroendocrine tumors (mNET) with magnetic resonance imaging (MRI). Methods: MRI examinations of 24 patients with hepatic metastases from pNET were quantitatively and qualitatively assessed by two blinded readers and compared to those obtained in 23 patients with hepatic metastases from mNET. Inter-reader agreement was calculated with kappa and intraclass correlation coefficient (ICC). Sensitivity, specificity and accuracy of each variable for the diagnosis of hepatic metastasis from pNET were calculated. Associations between variables and primary tumor (i.e., pNET vs. mNET) were assessed at univariate and multivariate analysis. A nomogram was developed and validated using an external cohort of 20 patients with pNET and 20 patients with mNET. Results: Interobserver agreement was strong to perfect (k=0.893-1) for qualitative criteria and excellent for quantitative variables (ICC: 0.9817-0.9996). At univariate analysis, homogeneity on T1-weighted images was the most discriminating variable for the diagnosis of pNET (OR, 6.417; P=0.013) with greatest sensitivity (88%; 21/24; 95% CI: 68-97%). At multivariate analysis, tumor homogeneity on T1-weighted images (P=0.007; OR, 17.607; 95%CI: 2.179–142.295) and target sign on DW images (P=0.007; OR, 19.869; 95%CI: 2.305–171.276) were independently associated with pNET. Nomogram yielded a corrected AUC of 0.894 (95%CI: 0.796–0.992) for the diagnosis of pNET in the training cohort and 0.805 (95%CI: 0.662–0.948) in the validation cohort. Conclusions: MRI provides qualitative features that can help discriminate between hepatic metastases from pNET and those from mNET.

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Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546517695789 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2000-2009 ◽

Cited By ~ 22

Author(s):

Pietro Randelli ◽

Carlo Alberto Stoppani ◽

Carlo Zaolino ◽

Alessandra Menon ◽

Filippo Randelli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Randomized Controlled Trial ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Controlled Trial ◽

Resonance Imaging ◽

Randomized Controlled ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. Purpose: To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Results: Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). Conclusion: No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).

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Variation among Argentinean Orthopedics Surgeons in the Indications in Rotator Cuff Lesions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00197 ◽

2018 ◽

Vol 6 (12_suppl5) ◽

pp. 2325967118S0019

Author(s):

Cristian Robles ◽

Gerardo Aguirre ◽

Mauro Cristiani ◽

Pablo Bertiche ◽

Esteban Lobos ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Young Patients ◽

Consensus Guidelines ◽

Open Technique ◽

Orthopedic Surgeons ◽

Rotator Cuff Lesions ◽

Cuff Repair ◽

Case Number ◽

Mini Open

Introduction: Indications in the treatment of rotator cuff lesions are widely discussed and not standardized. The aim of this study is to evaluate the variability among Argentinean orthopedic surgeons regarding the indications of treatment in different rotator cuff lesions. Methods: A questionnaire was designed based on the study carried out by Dunn et al. (JBJS Am 2005). Its aim was to gather the opinion of Argentine orthopedic surgeons on decision making concerning different rotator cuff lesions. Surgeons were divided into general orthopedic surgeons or shoulder specialists according to the number of shoulders treated surgically in the last year. The questionnaire has two sections: four hypothetical clinical cases and 11 questions about factors that could influence treatment selection. Results: Out of 556 questionnaires sent, 162 were completed, 117 by orthopedic surgeons and 45 by shoulder specialists. The specialists reported mostly arthroscopic repairs (57%), orthopedic surgeons reported repairing these lesions mainly by mini open or open technique (48% and 21% respectively). The highest agreement between both groups was evidenced in case number 1 (traumatic partial injuries in young patients (70% in favor of rotator cuff repair)). There was also agreement in the contraindication of the use of corticosteroids before surgery (p = 0.74), and in the repair of rotator cuff as a factor to prevent osteoarthritis (p = 0.27). Rotator cuff repair failure rate was considered to be 20%, not evidencing differences between groups. Conclusions: This study evidences the variation in indications between Argentinean surgeons in the treatment of rotator cuff lesions. The variability in the management of these patients, makes it difficult to establish protocols of treatment, or consensus guidelines to help standardize treatments for these injuries

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