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. 2021 Oct;91(10):2145-2152.
doi: 10.1111/ans.17164. Epub 2021 Aug 25.

Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury

Patrick Groarke  1   2 , Simond Jagernauth  1   2 , Susan E Peters  1   3 , Silvia Manzanero  1 , Paul O'Connell  4 , Greg Cowderoy  4 , David Gilpin  1 , Benjamin Hope  1   2 , Darren Marchant  1 , Kenneth Cutbush  5 , Steve Andrews  1   2 , Phillip Fr Duke  1   2 , Mark Ross  1   2   5
Affiliations

Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury

Patrick Groarke et al. ANZ J Surg. 2021 Oct.

Abstract

Background: Advances in shoulder magnetic resonance imaging (MRI) and arthrography (MRA) have revolutionised musculoskeletal diagnosis and surgical planning. Despite this, the overall accuracy of MRI, with or without intra-articular contrast, can be variable.

Methods: In this prospective non-randomised analysis, 200 participants (74.5% males) with suspected shoulder injuries underwent MRI (41.0%) or MRA followed by arthroscopy. A study specific proforma was developed to ensure consistency of reporting by radiologists and surgeons. The reports were compared to assess the predictive power of MRI/MRA. Specific assessment of rotator cuff tendon appearance, long head of biceps (LHB) tendon appearance, position and anchor, subacromial space, glenoid labrum and humeral cartilage grade were included.

Results: Shoulder MRA demonstrated a higher agreement with arthroscopy than MRI for supraspinatus, infraspinatus and subscapularis tendon appearance (κ = 0.77 vs. κ = 0.61, κ = 0.55 vs. κ = 0.53 and κ = 0.58 vs. κ = 0.46 respectively). There were also superior agreement rates with MRA compared to MRI for LHB tendon appearance (κ = 0.70 vs. κ =0.54) and position (κ = 0.89 vs. κ = 0.72). As an overall assessor of shoulder pathology we found significantly higher total agreement scores when MRA was used (p = 0.002).

Discussion: Whilst magnetic resonance imaging with arthrography is an extremely useful tool to assess underlying pathological shoulder states it does not confer 100% accuracy. In cases whereby this modality is inconclusive, an examination under anaesthesia and diagnostic arthroscopic assessment for the detection of intra-articular shoulder pathology may be considered.

Keywords: arthroscopy; magnetic resonance; sensitivity; shoulder; specificity.

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