MRI-Arthroscopic Correlation in Rotator Cuff Tendon Pathologies; A Comparison between Various Centers

Document Type : RESEARCH PAPER


1 Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Magnetic resonance imaging (MRI) has long been considered a perfect imaging study for evaluation of shoulder pathologies despite occasional discrepancies between MR reports and arthroscopic findings. In this study we aim to evaluate impact of imaging center as an indicator of image quality on accuracy of MRI reports in diagnosis of rotator cuff tendon pathologies.
Methods: We reviewed MR reports of 64 patients who underwent arthroscopy in university center hospital. MRIs were done in various centers including both university-affiliated and out-centers. All studies were reported by two radiologists in consensus unaware of the arthroscopic results or previous reports. An inter-observer agreement analysis using the kappa statistics was performed to determine consistency among imaging and surgical reports.
Results: Kappa values for out-centers were as follows: 0.785 for biceps, 0.469 for suscapularis, 0.846 for supraspinatus and 0.785 for infraspinatus tendons. In university centers values were 0.799 for biceps, 0.802 for suscapularis, 0.789 for supraspinatus and 0.770 for infraspinatus tendons.
Conclusion: Image reporting in university centers with proficient sequences increased accuracy of diagnosis in 3/4 of evaluated features and showed subtle decreased inter-observer agreement in 1/4 of features. Uniformity of the scanners and protocols as well as evaluation on a workstation rather than hard copies cumulatively resulted in a meaningful increase in the accuracy of the same radiologists in diagnosis of rotator cuff tendon tear.


  1. Magee T, Shapiro M, Williams D. Comparison of high-field-strength versus low-field-strength MRI of the shoulder. AJR Am J Roentgenol. 2003; 181(5):1211–5.
  2. Lee CS, Davis S., McGroder C, Kouk S, Sung RM, Stetson WB, et al. Analysis of low-field MRI scanners for evaluation of shoulder pathology based on arthroscopy. Orthop J Sports Med. 2014; 2(7):1-7.
  3. Loew R, Kreitner KF, Runkel M, Zoellner J, Thelen M. MR arthrography of the shoulder: comparison of low-field (0.2 T) vs high-field (1.5 T) imaging. Eur Radiol. 2000; 10(6):989-96.
  4. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999; 213(3):709-14.
  5. Chingkoe CM, White JH, Louis LJ, Andrews G, Forster BB. Rotator cuff troublemakers: pitfalls of MRI and ultrasound. Open Access J Sports Med. 2009; 2010(1):1–9.
  6. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005; 37(5):360-3.
  7. Joshi UP, Puri S. Clinical, MRI and arthroscopic correlation in anterior and posterior shoulder instability. Int J Res Med Sci. 2014; 2(3):857-60.
  8. Jana M, Srivastava DN, Sharma R, Gamanagatti S, Nag HL, Mittal R, et al. Magnetic resonance arthrography for assessing severity of glenohumeral labroligamentous lesions. J Orthop Surg. 2012; 20(2):230-5.
  9. Dietrich TJ, Ulbrich EJ, Zanetti M, Fucentese SF, Pfirrmann CW. PROPELLER technique to improve image quality of MRI of the shoulder. AJR Am Roentgenol. 2011; 197(6):W1093–100.
  10. Polster JM, Schickendantz MS. Shoulder MRI: what do we miss? AJR Am J Roentgenol. 2010; 195(3):577–84.
  11. Momenzadeh OR, Gerami MH, Sefidbakht S, Dehghani S. Assessment of correlation between MRI and arthroscopic pathologic findings in the shoulder joint. Arch Bone Jt Surg. 2015; 3(4):286-90.
  12. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography and ultrasound in the diagnosis of  rotator cuff tears: a meta analysis. AJR Am J Roentgenol. 2009; 192(6):1701–7.
  13. Choi JH, Suh S, Kim BH, Cha SH, Kim MG, Lee KY, et al. Comparison between conventional MR artgrography and abduction and external rotation MR arthrography in revealing tears of the antero-inferior glenoid labrum. Korean J Radiol. 2001; 2(4):216-21.
  14. Chun KA, Kim MS, Kim YJ. Comparisons of the various partial-thickness rotator cuff tears on MR arthrography and arthroscopic correlation. Korean J Radiol. 2010; 11(5):528-35.
  15. Halma JJ, Eshuis R, Krebbers YM, WeitsT, Gast A. Interdisciplinary inter-observer Agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Arch Orthop Trauma Surg. 2012; 132(3):311–20.
  16. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003; 7(29):1-166.
  17. Hodgson RJ, O’Connor PJ, Grainger AJ. Tendon and ligament imaging. Br J Radiol. 2012; 85(1016):1157–72.