Can We Apply Snyder's Arthroscopic Classification to Ultrasound for Evaluating Rotator Cuff Tears? A Comparative Study with MR Arthrography

Abstract

We aimed to demonstrate the applicability of Snyder's arthroscopic classification of rotator cuff tears (RCT) in shoulder ultrasound (US) and to compare it with MR arthrography (MRA). Forty-six patients (34 males; mean age:34 ± 14 years) underwent shoulder US and MRA. Two radiologists (R1 = 25 years of experience; R2 = 2 years of experience) assigned A1-4, B1-4, or C1-4 values depending on the extent of RCT in both US and MRA. Inter-reader intra-modality and intra-reader inter-modality agreement were calculated using Cohen's kappa coefficient. US sensitivity and specificity of both readers were calculated using MRA as the gold standard. Patients were divided into intact cuff vs. tears, mild (A1/B1) vs. moderate (A2-3/B2-3) tears, mild-moderate (A2/B2) vs. high-moderate (A3/B3) cuff tears, moderate (A2-3/B2-3) vs. advanced (A4/B4) and full-thickness (C) tears. The highest agreement values in inter-reader US evaluation were observed for mild-moderate vs. high-moderate RCT (K = 0.745), in inter-reader MRA evaluation for mild vs. moderate RCT (K = 0.821), in R1 inter-modality (US-MRA) for mild-moderate vs. high-moderate and moderate vs. advanced/full-thickness RCT (K = 1.000), in R2 inter-modality (US-MRA) for moderate vs. advanced/full-thickness RCT (K = 1.000). US sensitivity ranged from 88.89%(R1)-84.62%(R2) to 100% (both readers), while specificity from 77.78%(R1)-90.00%(R2) to 100% (both readers). Snyder's classification can be used in US to ensure the correct detection and characterization of RCT.

Keywords: Snyder’s classification; magnetic resonance arthrography; rotator cuff tears; shoulder; ultrasound.

Figure 1

US images on the long axis (A) and short axis (B), coronal T1-weighted (C), and sagittal T1-weighted (D) MRA images of a 57-year-old male patient with complete supraspinatus tendon rupture.