Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

Author(s)

Lucas Busnardo Ramadan ^[1] ; Eduardo Baptista ^[2] ; Felipe Ferreira de Souza ^[3] ; Mauro Emilio Conforto Gracitelli ^[4] ; Jorge Henrique Assunção ^[5] ; Fernando Brandao Andrade-Silva ^[6] ; Arnaldo Amado Ferreira-Neto ^[7] ; Eduardo Angeli Malavolta ^[8]

Affiliation

^[1] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[2] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[3] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[4] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[5] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[6] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[7] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

^[8] Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP - Brasil

• Document type: Journal article
• Source: São Paulo Medical Journal; v. 138, n. 4, p. 310-316, 2020-08-21.

Abstract

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall. (AU)

• FAPESP's process: 17/02896-2 - Accuracy of preoperative MRI in the diagnosis of subscapularis tears: prospective study
• Grantee: Eduardo Angeli Malavolta
• Support Opportunities: Regular Research Grants