Investig Magn Reson Imaging.  2018 Dec;22(4):229-239. 10.13104/imri.2018.22.4.229.

Diagnosis of Rotator Cuff Tears with Non-Arthrographic MR Imaging: 3D Fat-Suppressed Isotropic Intermediate-Weighted Turbo Spin-Echo Sequence versus Conventional 2D Sequences at 3T

• Hong WS
• Jee WH
• Lee SY
• Chun CW
• Jung JY
• Kim YS

• KMID: 2431107
• DOI: http://doi.org/10.13104/imri.2018.22.4.229

Abstract

PURPOSE
To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences.
MATERIALS AND METHODS
Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE.
RESULTS
The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSE-SPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05).
CONCLUSION
TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

Keyword

Rotator cuff; Magnetic resonance imaging; Non-arthrographic; 3D isotropic; SPACE

MeSH Terms

Area Under Curve
Diagnosis*
Humans
Magnetic Resonance Imaging*
Retrospective Studies
Rotator Cuff*
Sensitivity and Specificity
Shoulder
Tears*
Tendons

Figure

• 

  Fig. 1. Flow diagram of the study. AVN = avascular necrosis; CE = contrast-enhancement; GCT = giant cell tumor; PVNS = pigmented villonodular synovitis; TSE-SPACE = three-dimensional isotropic fat-suppressed turbo spin-echo SPACE intermediate-weighted image

• 

  Fig. 2. Non-arthrographic MR images show arthroscopically-proven partial-thickness articular-sided tear of the SST-IST in a 68-year-old woman. (a) Oblique coronal fat-suppressed T2-weighted image and (b) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image show a partial-thickness articular-sided tear (arrows) of the SST-IST. All three readers correctly interpreted this case on both 2D sequences and TSE-SPACE.

• 

  Fig. 3. Non-arthrographic MR images show arthroscopically-proven partial-thickness bursal-sided tear of SST-IST and intact SCT in a 55-year-old man. (a) Oblique coronal fat-suppressed T2-weighted image and (b) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image show a partial-thickness bursal-sided tear (arrows) of the SST-IST. (c) Oblique sagittal fat-suppressed T2-weighted image and (d) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE image with an oblique sagittal reformatted image show a subtle high signal intensity focus at the articular surface of SCT, which involves the superior portion of the tendon (arrows). A subcortical cyst is noted in the lesser tuberosity of proximal humerus. All three readers correctly interpreted the SST-IST on both 2D sequences and TSE-SPACE. However, they misinterpreted the SCT on both 2D sequences and TSE-SPACE.

• 

  Fig. 4. Non-arthrographic MR images show arthroscopically-proven grade 2 partial-thickness articular-sided tear of the SCT in a 56-year-old woman. (a, b) Axial and oblique sagittal fat-suppressed T2-weighted images and (c, d) 3D isotropic fat-suppressed intermediate-weighted TSE-SPACE images with an axial and an oblique sagittal reformation show a high signal intensity area at the articular surface of SCT, which involves more than one third of the craniocaudal diameter of the tendon (arrows). A subcortical cyst is present in the lesser tuberosity of proximal humerus. All three readers correctly interpreted this case on both 2D sequences and TSE-SPACE.

Reference

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